Scintillation Brain Scanning in Children

Abstract

SCINTILLATION brain scanning is a useful, simple, and relatively innocuous procedure for the detection and localization of intracranial disease in the pediatric age\ x=req-\ group. Because scintillation scanning methods have in the last decade become quite sophisticated, they now represent an important diagnostic tool. The purpose of this paper is to present general principles of scintillation brain scanning and our experience with it in children through illustrative case material.It is not our intention to compare the accuracy of brain scanning with that of radiographic contrast studies in children. We do not have enough cases to do this with validity, and in any event we feel that these various procedures should be regarded as adjuncts, not competitors. The virtue of brain scanning as compared to contrast studies lies not in greater accuracy of detection but in complete absence of morbidity and mortality. Moreover, when successful in detecting a space-occupying lesion it generally provides a more precise localization. With the exception of "tumor stain" on arteriography, rarely seen unless serialographic studies are done, and even then seen in only a small percentage, only the brain scan actually gives a visual image of a mass lesion. Cerebral air studies, electroencephalo¬ grams, and most arteriograms provide only (Dr. Beiler).indirect evidence of the presence of mass le¬ sions. Moreover, a recent study shows that the size of intracranial mass lesions larger than 2.5 cm proved at autopsy to be within 1 to 2 cm of the size depicted on the brain scan.1 The lesions smaller than 2.5 cm were usually not found on brain scans.Localization of cerebral lesions by external -counting began with the work of Moore 2 in 1948, who used lslI-labeled fluorescein.Radioiodinated human serum albumin (IHSA) was introduced in 1952 by Peyton and associates.3 Since then, several other isotopes and compounds have been found useful as brain-scanning agents, including chlormerodrin Hg 197 or chlormerodrin Hg 203, and most recently, 99mTc in the form of sodium pertechnetate. Each of these has certain advantages and disadvantages, but none has been shown to be clearly superior to any of the others in terms of the per¬ centage of correct localizations obtainable.On the other hand, radioisotope scanning de¬ vices have improved profoundly in the last decade. Recent development of better short¬ lived radiopharmaceuticals has reduced the radiation dose and shortened the time re¬ quired. Future improvements in scanning will probably depend largely on better and more specific radiopharmaceutical agents. A good general review of clinical scintillation scan¬ ning may be found in a symposium edited by Quinn.4 It is important to bear in mind that none of these presently used labeled compounds Downloaded From: http://archpedi.jamanetwork.com/ by a Oakland University User on 06/09/2015

Value of Brain Scanning in Pediatric Subdural Collections

“…The scan was positive in the 3 children with proven subdural empyema (Table 3). a few examples (7,11,15,18,21). In the group of Kaiffer (1 3), 7 scans out of 9 were positive.…”