A phantom study: Should¹²⁴I-mIBG PET/CT replace¹²³I-mIBG SPECT/CT?

Purpose: The isotope¹²³I is commonly labeled with meta-iodobenzylguanidine (mIBG) for imaging of neuroendocrine tumors, such as pheochromocytomas and neuroblastomas.¹²³I-mIBG SPECT/CT imaging is performed for staging, follow-up and selection of patients for treatment with¹³¹I mIBG. As an alternative to¹²³I,¹²⁴I-mIBG PET/CT may be used, potentially taking advantage of the superior PET image quality. The purpose of this study was to investigate whether¹²⁴I PET/ CT improves image quality as compared with¹²³I SPECT/CT for equal patient effective radiation dose (in mSv). Methods: Phantom measurements were performed using the NEMA-2007 image quality phantom. SPECT and PET reconstruction settings were used with and without time-of-flight (TOF) and point-spread-function (PSF) modeling. As a measure of image quality, the contrast-to-noise ratio (CNR) was calculated. The ratio of the¹²³Ito¹²⁴I activity concentration was determined at which the contrast-to-noise ratio was equal for both modalities. This metric was defined as the contrast equivalent activity ratio (CEAR). Results: CEARs of 47.7, 25.6, 23.1, 14.6, 10.0, and 9.1 were obtained for a TOF and PSF modeled¹²⁴I reconstruction method and an attenuation and scatter-corrected¹²³I reconstruction method for sphere sizes of 10 to 37 mm, respectively. As the effective radiation dose of¹²⁴I-mIBG is higher than of¹²³I-mIBG (in mSv/MBq), an equal effective dose corresponds to a CEAR of 5 to 10. Therefore, CEARs higher than 5 to 10 indicate that¹²⁴I PET/CT outperforms¹²³I SPECT/CT in the sense of image quality for equal patient effective radiation dose. Conclusion: The CEAR is much larger than a factor of 5 to 10 (needed for equal patient effective radiation dose) for most of the reconstruction methods and sphere sizes. Therefore,¹²⁴I-mIBG PET/ CT is expected to improve image quality and/or may be used to reduce effective patient dose as compared with¹²³I-mIBG SPECT/CT.