Northern Lincolnshire and Goole NHS Foundation Trust - Nuclear Medicine
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| SOP Code | Title | Review Date |
|---|---|---|
| REF018 | MIBG Tumour Imaging | 2028-01-15 |
| Authorised By | Authorising Role | Authorisation Signature (only on master paper copy) | Date Authorised |
|---|---|---|---|
| Prof G Avery | ARSAC Licence Holder | 2025-01-15 |
See REF000 - Referring to Nuclear Medicine (NLAG) for details on how to refer.
Iodine-123 labelled metaiodobenzylguanidine (MIBG) is a radiopharmaceutical of similar structure to noradrenaline and is used in the diagnosis and localisation of active catecholamine secreting tumours, such as phaeochromocytomas, and their metastases.
Appropriate biochemical markers and cross sectional imaging e.g. CT should have been performed prior to requesting MIBG. If biochemical markers are negative but a clinical suspicion remains then the request must be discussed with the ARSAC licence holder.
| ARSAC Licence Holders |
|---|
| Prof Ged Avery |
| Dr Najeeb Ahmed |
| Nuclide | Pharmaceutical Form | Local DRL (MBq) |
|---|---|---|
| I123 | MIBG | 400 |
| Radiopharmaceutical | CT Component of SPECT/CT | |
|---|---|---|
| Typical Radiation Dose (mSv) | 5.2 (with thyroid blocked) | 3.2 - 6.4 mSv |
| Patient Demographics | • Pregnancy • Breast-Feeding Patients • Renal Insufficiency[1] |
|---|---|
| Drugs | Many classes of drugs are known (or may be expected) to interfere with the uptake and/or vesicular storage of mIBG. A table including some of the most important medications that may affect the results of MIBG scintigraphy[2] is available from http://www.heynm.org.uk/pdfs/mibg_drug_stop_list.pdf |
130mg potassium iodide tablets per day for a total of 3 days, starting the day before the injection of I-123 MIBG and continuing for 2 further days (i.e. the night before the injection, the night of the injection and the following night)[1][2]
When thyroid blocking agents are administered to children, consideration should be given to reducing the dosage[3]. i.e.
If iodine is contraindicated, thyroid blockade can be carried out with potassium perchlorate (200 mg adult dose). If used, this should be administered 1 hour[3] prior to the administration of I-123 MIBG and repeated at 8 hour intervals[3] for 2 days[1].
It should be noted that currently potassium perchlorate is not licensed in the UK.
Care must be taken to ensure that drugs which interfere with MIBG uptake are discontinued (if possible) for an adequate time prior imaging. See http://www.heynm.org.uk/pdfs/mibg_drug_stop_list.pdf. Patients with metabolically active catecholamine secreting tumours (i.e. phaechromocytoma, paraganglioma) often receive alpha- or beta-blocking treatment. Therefore, drug interruption should be decided by consultation between the referring physician and the ARSAC licence holder, to enable evaluation of the patient’s condition. If it is decided to proceed without changing the medication, it should be noted that this could impair diagnostic accuracy[1][2]
| Investigation and localisation of suspected phaeochromocytoma |
| Investigation and localisation of suspected extra-adrenal phaeochromocytoma |
| Investigation and localisation of suspected phaeochromocytoma metastases |
| Assessment of the unilateral or bilateral nature of the disease |
| Assessment of the possible therapeutic use of iodine-131 MIBG |
| Investigation and localisation of suspected neuroblastoma |
| Investigation and localisation of suspected neuroblastoma metastases |
| Investigation and localisation of suspected carcinoid tumour |
| Assessment of suspected post-operative recurrence of disease |