A Consistently Elevated Pineal Gland Uptake of 18F-MFBG as a Physiological Normal Variant

A 3-year-old girl with high-risk neuroblastoma underwent ¹⁸ F-MFBG PET/CT for therapy response evaluation as part of a clinical trial. The scan revealed focal increased uptake in the pineal gland, which was also observed on a concurrent ⁶⁸ Ga-DOTATATE PET/CT. Brain MRI showed no signs of metastasis, and importantly, follow-up ¹⁸ F-MFBG PET/CT demonstrated consistently elevated uptake in the same region without interval change. These combined findings, negative MRI, concordant physiological ⁶⁸ Ga-DOTATATE uptake, and stable appearance on serial ¹⁸ F-MFBG PET/CT, support the interpretation of this pineal gland activity as a physiological normal variant rather than a pathologic lesion.