Availability, use and challenges of imaging modalities in neuroblastoma: A SIOPEN survey

Background: In children with neuroblastoma, imaging plays a central role in staging, treatment planning and response assessment. Standardized imaging procedures, including cross-sectional imaging and MIBG scintigraphy, are essential for consistency across international trials. However, the increasing use of PET tracers and variable access to imaging technologies may challenge harmonization. This study evaluated the availability, use, and challenges of neuroblastoma imaging modalities across participating centers. Methods: A web-based survey was distributed to SIOPEN national delegates between August and December 2025. The survey covered respondent characteristics, sedation availability, MIBG scintigraphy with SPECT/CT and PET imaging practices, anatomical imaging modalities, and perceived challenges. Descriptive analyses were performed. Results: In total, 151 responses representing 89 unique centers from 29 countries were analysed. Sedation for imaging was available in 98% of centers. In most centers MRI can be used for cross-sectional imaging of the primary tumor (73.1%). Most (74.2%) performed both planar and SPECT/CT MIBG scans, with 64.0% reporting use of the standardized SIOPEN scoring system. PET imaging was available in 84.3% of centers, most commonly using [F]FDG (95.9%); [F]MFBG was available in eight centers. Major challenges included limited tracer access (56.1%) and restricted cyclotron availability (25.8%). Conclusions: This study reveals wide access to nuclear imaging modalities, including PET imaging, but with substantial heterogeneity in neuroblastoma imaging practices, tracer availability and image interpretation across responding centers. These findings highlight the need for broader implementation of standardized imaging criteria. While informative, these results should be interpreted with caution given the potential biases inherent to questionnaire-based studies.