The guidelines summarize the views of the Paediatric Committee of the European Association of Nuclear Medicine. They should be taken in the context of "good practice" of nuclear medicine and of any national rules, which may apply to nuclear medicine examinations. The recommendations of these guidelines cannot be applied to all patients in all practice settings. The guidelines should not be deemed inclusive of all proper procedures or exclusive of other procedures reasonably directed to obtaining the same results.
The purpose of these guidelines is to offer nuclear medicine teams a framework that could prove helpful in daily practice. The guidelines include information related to the indications, acquisition, processing and interpretation of bone scans in children, focusing primarily on (99m)Tc-labelled diphosphonate scintigraphy, and also recommendations with regard to the emerging use of PET with (18)F-fluoride.
In children with VUR and suspected coexisting UPJ obstruction dynamic renal scintigraphy may support significant obstruction when hydronephrosis is at least moderate in degree or ureteral dilatation is present but is unlikely to do so if neither is observed.
Os calcaneus secundarius is an uncommon anatomic variant that usually has no symptoms. The authors describe a patient with foot pain in whom plain radiographs and computed tomography suggested an os calcaneus secundarius. Skeletal scintigraphy, by showing high uptake at the corresponding site, supported its contributory role in explaining the patient's symptoms. Fig. 1. Radiographs of a 12-year-old girl with left foot pain showed a small ossified fragment (arrow) adjacent to the anterior superior aspect of the calcaneus. Its location and appearance suggest that it is an os calcaneus secundarius, but an avulsion fracture of the anterior aspect of the calcaneus also could account for this finding.
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With increasing use of combined PET/CT scanners in the last few years, multimodality imaging (Nuclear Medicine/Radiology) found its way into clinical routine diagnostics. In this overview, necessary components for multimodality imaging, strategies for image analysis and image presentation, and diagnostic goals of combined imaging are demonstrated and discussed. A special focus is on the question, whether combined scanners can be replaced by a software approach with separated modalities. Advantages and limitations of multimodality imaging with combined or separated scanners are shown.
The purpose of these guidelines is to offer the nuclear medicine and the appropriate interdisciplinary team a framework for performing and reporting positron emission tomography (PET) and the combination with computed tomography (PET/CT) in children with malignant diseases mainly using the radiopharmaceutical 18F-fluorodeoxy-glucose (FDG). These guidelines are based on the recent guidelines of the Paediatric Committee of the European Association of Nuclear Medicine (EANM) (57) and have been translated and adapted to the current conditions in Germany. The adaptation of CT-parameters using PET/CT in children is covered in a more detailed way than in the EANM guideline taking into account that in Germany already a good portion of PET examinations is performed using an integrated PET/CT-scanner. Furthermore, a CT-scan without adoption of the CT acquisition parameters would result in a not tolerably high radiation exposition of the child. There are excellent guidelines for FDG PET and PET/CT in oncology published by the German Society of Nuclear Medicine (Deutsche Gesellschaft für Nuklearmedizin, DGN) (42) and EANM (4). These guidelines aim at providing additional information on issues particularly relevant to PET and PET/CT imaging in children. These guidelines should be taken in the context of local and national current standards of quality and rules.
Tc-99m dimercaptosuccinic acid (DMSA) SPECT in a 14-month-old boy with right vesicoureteric reflux showed an unusual site of tracer accumulation in the left inguinal region. The possibility that this reflected partialdose extravasation with resultant lymphatic tracer absorption was supported by an image of the left foot that showed evidence of partial-dose extravasation. Lymphatic absorption and focal nodal localization after partial-dose extravasation has been documented with skeletal tracers. This case illustrates that it can also occur with Tc-99m DMSA.
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