Could somatostatin scintigraphy be superior to MIBG scan in the staging of stage IVs neuroblastoma (Pepper's syndrome)?

A 4-month-old infant suffering from Stage IVs neuroblastoma (NB IVs; Pepper's syndrome) was repeatedly examined by I-123 MIBG and somatostatin analog in-111 pentetreotide (SMS) scintigraphy, during a 2-year period. Treatment was restricted to surgery of the primary tumor. I-123 MIBG and SMS scan results were positive in the primary tumor and liver, but I-123 MIBG yielded very poor images and failed to reliably detect bone marrow metastases in the lower limbs and skull, whereas SMS precisely visualized these lesions. Six months after diagnosis, the infant was in complete clinical remission. I-123 MIBG and SMS images had returned to normal at 1 year. The prognostic implication of positive SMS imaging, in combination with positive or negative I-123 MIBG scan results, is not known in NB IVs and requires further investigation.