Head-to-Head Comparison of Neuroblastoma Detection by [ 64 Cu]GD2 PET and [ 123 I]MIBG SPECT

123I-labeled metaiodobenzylguanidine ([123I]MIBG) SPECT is well-established for neuroblastoma diagnostics. Nevertheless, therapies targeting GD2 on neuroblastoma gain clinical importance in standard treatment and clinical trials, which emphasizes the relevance of PET using the radiolabeled GD2 antibody [64Cu]Cu-NOTA-ch14.18/CHO ([64Cu]GD2) for noninvasive detection of GD2 expression. Here, we present an initial comparison of the diagnostic performance of [64Cu]GD2 PET and [123I]MIBG SPECT. Methods: Five patients with neuroblastoma underwent [123I]MIBG SPECT, [64Cu]GD2 PET, and MRI. The detected lesions were compared between [123I]MIBG and [64Cu]GD2 using International Society of Pediatric Oncology Europe Neuroblastoma (SIOPEN) and modified Curie scores. Results: Three patients suffered from multiple metastases, and 2 patients presented solitary lymph node metastases. Both modalities detected lesions in every patient; [64Cu]GD2 revealed additional lesions in patients with multiple metastases compared with [123I]MIBG, leading to higher SIOPEN and modified Curie scores. Conclusion: These initial data indicate the diagnostic suitability of [64Cu]GD2 for detection of neuroblastoma metastasis.