Neuroblastoma is an embryonal tumor of children that frequently presents with metastases. Our patient is a 6-year-old girl who was diagnosed to have neuroblastoma with diffuse metastatic disease throughout the skeleton as seen in her 123I-MIBG scan in the United States. 18F-FDG PET/CT scan was done in the Philippines after chemotherapy and gene therapy, and before 131I-MIBG therapy. No additional lesions were seen on PET.  131I-MIBG was then performed and an 131I-MIBG with SPECT/CT thereafter, which showed an increase in size and extent of the lesion in the head and a decrease in number of the skeletal metastases. New 131I-MIBG-avid posterior cervical lymph nodes were also localized through SPECT/CT. For this patient, a follow-up 123I/131I-MIBG scan would be more cost-effective in assessing response to therapy. Sectional imaging may be done to obviate the need for sedation of this young patient.