Pediatric Nuclear Medicine and Molecular Imaging

Description

This pioneering book, now in its fourth edition, presents the cutting-edge developments in pediatric nuclear medicine. Thoroughly revised and updated, it retains the fundamentals that anchor the book’s distinguished reputation and includes the latest advances in PET/CT, SPECT, hybrid imaging, and molecular imaging. Pediatric Nuclear Medicine and Molecular Imaging, Fourth Edition, is an excellent resource for nuclear medicine physicians, diagnostic radiologists, pediatricians, and residents and fellows. The Fourth Edition features: ·         16 new chapters, including PET and PET/CT in Children and Young Adults; Lymphoscintigraphy; Skeletal Scintigraphy; Neuroblastoma; Lymphomas and Lymphoproliferative Disorders; Functional Imaging of Pediatric Musculoskeletal Tumors; Solid Tumors in Childhood; Pediatric Molecular Imaging; Combined PET/MRI in Childhood; Radiation Exposures; Radiation Protection in Pediatric Nuclear Medicine; and Dose Optimization in Pediatric Nuclear Medicine.  ·         Discussion of the use of image fusion and hybrid imaging in children. ·         Strategies for communicating potential radiation risk to patients, families and members of the healthcare team. ·         Methods to optimize pediatric radiopharmaceutical administered doses and improve image quality. S. Ted Treves, MD, is Professor of Radiology at Harvard Medical School, Founder and Former Chief, Division of Nuclear Medicine and Molecular Imaging, Ch ildren’s Hospital Boston (1970-2011). In 2013, he received the Society of Nuclear Medicine and Molecular Imaging’s Georg Charles de Hevesy Nuclear Pioneer Award for outstanding contributions to the field of Nuclear Medicine. Foreword Preface Acknowledgements Contents Contributors 1: General Aspects of Pediatric Nuclear Medicine The Consultation Interaction with Patients and Families Physical Environment Waiting Room Radiopharmacy Radiopharmaceutical Administration: Examination Room Imaging Rooms Performing the Study Imaging Infants and Young Children Instrumentation and Equipment Collimators Image Fusion and Systems Integration Radiopharmaceutical Administration Intravenous Administration Radiopharmaceutical Dose Adjustment Radionuclide Therapy Radiation Exposure and Risk Appendix 1: Example of a Patient/Parent Brochure About a Nuclear Medicine Procedure Bone Scan in Nuclear Medicine References 2: Sedation and General Anesthesia The Depths of Sedation Guidelines for Sedation Practice, Monitoring, and Qualifications Setting Up a Sedation and Anesthesia Service Patient Selection Risks of Sedation and Anesthesia Most Common Medications Used in Pediatric Sedation Chloral Hydrate and Pentobarbital Midazolam Dexmedetomidine Ketamine Propofol Ketorolac and Other Non-opioid Analgesics Narcotics Combination Therapy Challenges in Nuclear Medicine Radiation Safety Duration and Timing of Procedures Combination Studies Painful Procedures Bladder Catheterization Summary References 3: PET and PET/CT in Children and Young Adults Radiopharmaceuticals [ 18 F] Sodium Fluoride 18 F-Fluoro-2-Deoxyglucose Other PET Radiopharmaceuticals Patient Preparation for 18 F-FDG PET and 18 F-FDG PET/CT PET Acquisition Special Issues Image Co-registration PET/CT Normal Patterns of FDG Uptake Summary References 4: Central Nervous System: The Brain and Cerebrospinal Fluid Part 1: The Brain Clinical Applications Normal Brain Development Childhood Epilepsy Imaging in Epilepsy Ictal Perfusion SPECT An Injector System for Ictal SPECT Infantile Spasms Tuberous Sclerosis Cerebrovascular Disease of Childhood Moyamoya Disease Other Forms of Childhood Cerebrovascular Disease Alternating Hemiplegia Attention Deficit/Hyperactivity Disorder Complications of Extracorporeal Membrane Oxygenation Effect of Hypothermia and Hypoxia Developmental and Neuropsychiatric Disorders Brain Tumors Imaging Image Fusion Radiopharmaceuticals Postsurgical Seizures Brain Death Radiopharmaceuticals Perfusion Radiopharmaceuticals Technetium-99m-ECD Technetium-99m-HMPAO Iodine-123–Iodoamphetamine Xenon-133 Tumor-Avid Radiopharmaceuticals Fluoro-2-Deoxyglucose Thallium-201 Technetium-99m-MIBI and  99m Tc-Tetrofosmin Carbon-11-Labeled Methionine Receptor-Specific Radiopharmaceuticals Radiopharmaceuticals Normally Excluded from the Brain Imaging Methods Cerebral Perfusion SPECT Methods for Perfusion Brain SPECT Radiopharmaceutical Dosimetry ( 99m Tc-HMPAO and 99m Tc-ECD) Tumor Perfusion SPECT Cerebral Radionuclide Angiography and Planar Scintigraphy Part 2: Cerebrospinal Fluid 1 Cerebrospinal Fluid Normal Cerebrospinal Fluid Physiology Abnormal Cerebrospinal Fluid Physiology Diminished Absorption Overproduction Method Clinical Applications Normal Radionuclide Cisternogram Hydrocephalus Cerebrospinal Fluid Liquorrhea Loculations of Cerebrospinal Fluid Porencephalic Cyst Block of Spinal Cerebrospinal Fluid Flow Cerebrospinal Fluid Shunts Method of Assessment Clinical Applications Quantification of Cerebrospinal Fluid Shunt Flow References 5: Thyroid Methods Radiopharmaceuticals Iodine-131 Iodine-123 Iodine-124 Technetium-99m Sodium Pertechnetate Thyroid Scintigraphy Thyroid Uptake Factors Affecting Thyroid Studies Body Scans Using Radioiodine Clinical Applications Congenital Hypothyroidism Evaluation of Hyperthyroidism Treatment of Hyperthyroidism Radioiodine Therapy for Hyperthyroidism Thyroid Nodules Thyroid Cancer Therapy of Thyroid Cancer Whole Body Scans in the Management of Thyroid Cancer Evaluation and Follow-Up of Patients with Thyroid Cancer Management of Non-iodine-avid Thyroid Cancer Incidental Findings on FDG-PET References 6: Lung Imaging Methods Assessment of Pulmonary Blood Flow Lung Ventilation Scintigraphy 133 Xe for Inhalation Lung Ventilation with 99m Tc-Labeled Aerosols Clinical Applications Congenital Heart Disease Pulmonary Shunting Parenchymal and Bronchial Lung Disease Airway Obstruction Structural Abnormalities of the Chest Pulmonary Embolism Other Causes of Pulmonary Perfusion Defects References 7: Cardiovascular System Imaging of the Myocardium Clinical Applications Kawasaki Disease Takayasu Disease Transposition of the Great Arteries: Arterial Switch Operation Anomalous Left Coronary Artery Cardiac Transplantation Cardiomyopathy Chest Pain and Trauma Right Ventricular Hypertrophy and Hypertension Pulmonary Atresia with Intact Ventricular Septum Approaches to Imaging the Myocardium Single Photon Emission Computed Tomography (SPECT) Radiopharmaceuticals Technetium-99m-Sestamibi Technetium-99-Tetrofosmin Thallium-201 Neuronal Single Photon Emission Computed Tomography Tracer ( 123 I-MIBG) Technique for Myocardial Perfusion Imaging Usual Administered Doses of 99m Tc- Single SPECT Perfusion Imaging Rest and Exercise 99m Tc-Sestamibi SPECT Studies (Same-Day Protocol) Patient Preparation and Procedure New Dedicated Detector Systems Positron Emission Tomography (PET) Radiopharmaceuticals Rubidium-82 Nitrogen-13 Ammonia Oxygen-15 Water Fluorine-18-Labeled Myocardial Perfusion Agents Perfusion Imaging Dose Schedules for Myocardial Perfusion Tracers for PET Nitrogen-13 Ammonia Rubidium-82 Patient Preparation and Procedures Technical Aspects of Pharmacologic Vasodilator Stress Imaging Metabolism with Positron Emission Tomography Dose Schedules for Metabolic Imaging with FDG and PET Current Developments in Positron Emission Tomographic Imaging Assessment of Ventricular Function Clinical Applications Gated Blood Pool In Vitro Labeling of Red Blood Cells Technique for Gated Blood Pool Imaging Data Recording Analysis Valvular Regurgitation Diagnosis and Quantitation of Left-to-Right Shunts and Ventricular Function with First-Pass Radionuclide Angiocardiography Clinical Applications Detection and Quantitation of Left-to- Radiopharmaceuticals Imaging Technique Data Recording Injection Technique Quality Control Analysis Assessment of Right and Left Ventricular Ejection Fraction Right-to-Left Shunts Venography and Evaluation of Central Venous Lines Radionuclide Venography Radiopharmaceuticals Imaging Technique Assessment of Pulmonary Blood Flow Appendix A Quantitation of Left-to-Right Shunts Analytic Model Gamma-Variate Analysis Correction for Radiotracer Delivery Appendix B Ultrashort-Lived Radionuclides References 8: Lymphoscintigraphy Methods Radiopharmaceuticals 99m Tc-Labeled Sulfur Colloid (Filtered) 99m Tc-Tilmanocept Other 99m Tc-Labeled Agents Procedures Evaluation of Lymphatic Function Sentinel Lymph Node Localization Clinical Lymphedema Sentinel Lymph Node Localization References 9: Gastroesophageal Reflux, Gastric Emptying, Esophageal Transit, and Pulmonary Aspiration Gastroesophageal Reflux Definition, Pathophysiology, and Clinical Manifestations Diagnosis of Gastroesophageal Reflux Extended Esophageal pH Monitoring Multiple, Intraluminal Electrical Impedance Sonography Barium Contrast Radiography Endoscopy and Biopsy Gastroesophageal Reflux Scintigraphy Interpretation of Gastroesophageal Reflux Scintigraphy Treatment Gastric Emptying Physiology Clinical Manifestations and Management of Abnormal Gastric Emptying Diagnostic Evaluation of Gastric Emptying Gastric Emptying Scintigraphy Investigational Scintigraphic Techniques Esophageal Transit Anatomy and Physiology of the Esophagus Esophageal Transit Disorders Evaluation of Esophageal Transit Non-scintigraphic Techniques Esophageal Transit Scintigraphy Study Protocol Image Processing and Interpretation 99m Tc-Sucralfate Scintigraphy Pulmonary Aspiration Gastroesophageal Reflux Scintigraphy for Detection of Pulmonary Aspiration Aspiration of Saliva and the Radionuclide Salivagram Study Technique and Interpretation Other Techniques for Detection of Aspiration Scintigraphic Swallowing Studies Non-imaging Techniques for Evaluation of Pulmonary Aspiration Prevention of Pulmonary Aspiration References 10: Liver and Spleen Methods Hepatobiliary Scintigraphy Patient Preparation Pharmacologic Interventions Radiopharmaceuticals Administered Doses Imaging Method Evaluation Splenic Scintigraphy ( 99m Tc-­Denatured RBCs) Reticuloendothelial System Scintigraphy Radiopharmaceutical Imaging Method Clinical Applications Neonatal Jaundice Clinical Characteristics Etiology Differential Diagnosis Biliary Obstruction and Cholecystitis Choledochal Cyst Caroli’s Disease Biliary Leak Congenital Anomalies Diffuse and Focal Liver Disease Trauma Splenosis Accessory Spleen Splenic Torsion and Wandering Spleen Nonvisualization of the Spleen (“Functional Asplenia”) Splenic Abscess Liver Transplantation Liver and Spleen Size Normal Variants References 11: Gastrointestinal Bleeding Etiology Evaluation and Management Meckel’s Diverticulum Technetium-99m Pertechnetate ( 99m Tc-O 4 −) Abdominal Scintigraphy Indications Radiopharmaceutical Imaging Prior Bleeding Study Clinical Applications Normal Pertechnetate Abdominal Scintigraphy Meckel’s Diverticulum Abnormal Uptake Due to Other Causes Accuracy Technetium-99m-RBC Scintigraphy Radiopharmaceutical Imaging Clinical Application Technetium-99m-Sulfur Colloid Scintigraphy References 12: Kidneys Dynamic Renal Scintigraphy Procedure Radiopharmaceuticals and Administered Doses 99m Tc-MAG3 99m Tc-DTPA 99m Tc-Glucoheptonate 123 I-Orthoiodohippurate (OIH) The Renogram: Procedure Imaging: Radionuclide Angiography Imaging: Dynamic Renal Scintigraphy Imaging: MRI Urography Imaging: Diuretic Renography Processing and Display The Renogram: Interpretation Interpretation of Renal Radionuclide Angiography Interpretation of the Renogram Parenchymal Phase Total Renal Function Split or Differential Renal Function Kidney Size and Position Morphology of Functioning Renal Parenchyma Cortical Transit Time Interpretation of the Diuretic Renogram Advanced Image Processing Renal Cortical Scintigraphy Patient Preparation Radiopharmaceutical and Administered Doses 99m Tc-DMSA Renal Scintigraphy: Imaging Planar Renal Scintigraphy Magnification Renal Scintigraphy Advanced Image Processing Single Photon Emission Computed Tomography (SPECT) Iterative Reconstruction Measurement of Renal Volumes with SPECT Clinical Applications Renal Immaturity/Neonatal Period Hydronephrosis/Obstruction Pyelonephritis Clinical Features Vesicoureteral Reflux and Pyelonephritis Cortical Scintigraphy of Pyelonephritis Intravenous Urography and Renal Ultrasonography Renal Vein Thrombosis Renal Infarction Hypertension Congenital Anomalies Ectopic Kidney and Solitary Kidney Horseshoe Kidney Duplication Polycystic Kidney Disease Multicystic Dysplastic Kidneys Prune-Belly Syndrome Renal Trauma Acute Renal Failure Tumors Effect of Radiotherapy Renal Transplantation Living Renal Donors Recipients of Renal Transplants Thrombosis Rejection Obstruction Urinary Leak Transplantation of Adult Kidneys into Babies Appendix: Quantitative Analysis of Renal Function Correction for Tissue Attenuation and Detection of Extrarenal Activity Deconvolution Analysis Interpretation of the Renal Retention Function Glomerular Filtration Rate Effective Renal Plasma Flow References 13: Vesicoureteral Reflux and Radionuclide Cystography The Ureterovesical Junction Incidence Diagnosis Grading the Severity of Vesicoureteric Reflux Variability of Low-Grade Vesicoureteric Reflux Spontaneous Cessation of Reflux Treatment Radionuclide Cystography Indications Methods Patient Preparation Direct Radionuclide Cystography Radiopharmaceutical Equipment and Recording Catheterization Filling and Voiding Functional Bladder Capacity Analysis of Radionuclide Cystography Reporting Results Vesicoureteric Reflux in Radionuclide Cystography Patterns of Reflux Bladder Emptying and Voiding Flow Rate Residual Bladder Volume Urine Culture Dosimetry Indirect Radionuclide Cystography Radiopharmaceuticals Recording Analysis Computerized Radionuclide Cystography Intravesical Pressure Analysis References 14: Radionuclide Determination of Glomerular Filtration Rate Methods Radiopharmaceuticals 99m Tc-DTPA 51 Cr-EDTA 125 I-Iothalamate Radionuclide GFR Methods Continuous Infusion Single Administration with Serial Blood Sampling Single Administration with a Single Blood Sample In Vivo Image-Based Determination of GFR Serial Blood Sampling Method: Procedure Serial Blood Sampling Method: Analysis Serial Blood Sampling Technique: Quality Control Correcting GFR for Body Size Normal Range for GFR References 15: Skeletal Scintigraphy: General Considerations Radiopharmaceuticals Technetium-99m-MDP Fluorine-18 Sodium Fluoride Imaging with 99m Tc-MDP Planar Imaging Radionuclide Angiography Immediate Tissue Phase Images Skeletal Phase Images Multispot Imaging Whole-Body Imaging Pinhole Magnification Scintigraphy SPECT Fluorine-18 Sodium Fluoride PET References 16: Sports Injuries Patient Preparation, Imaging Techniques, and Radiopharmaceuticals Clinical Applications Hybrid Imaging Osseous Stress, Deformity, and Fractures of the Upper and Lower Extremities Back Pain Complex Regional Pain Syndrome Other Causes of Pain in Pediatric Athletes Conclusion References 17: Child Abuse Fracture Patterns in Child Abuse Radiological Evaluation of Fractures Skeletal Survey Bone Scintigraphy Whole-Body MRI Rib Fractures Metaphyseal Fractures Long Bone Fractures Spinal Fractures Skull Fractures Conclusion References 18: The Role of Skeletal Scintigraphy in the Diagnosis and Management of Mandibular Growth Abnormalities and Asymmetry Study Acquisition, Reconstruction and Analysis Clinical Applications Unilateral Condylar Hyperplasia Planar Scintigraphy SPECT Imaging Clinical Case Examples Assessment of Surgical Therapy Assessment of Growth Symmetric Abnormalities Clinical Case Example Conclusion References 19: Neuroblastoma: Functional Imaging Metaiodobenzylguanidine (MIBG) Scintigraphy Patient Preparation Imaging Technique Clinical Applications Potential Pitfalls False-Positive Studies False-Negative Studies 99m Tc-Methylene Diphosphonate ( 99m Tc-MDP) Bone Scan Imaging Technique Clinical Applications Potential Pitfalls 18 F-Fluorodeoxyglucose (FDG) PET and PET/CT Patient Preparation Imaging Technique Clinical Applications Potential Pitfalls 131 I-MIBG Therapy References 20: Imaging Parathyroid and Neuroendocrine Tumors Parathyroid Imaging Method Radiopharmaceuticals 99m Tc-Sestamibi [ 201 Tl] Thallium Chloride Iodine-123 ( 123 I) Technetium-99m Sodium Pertechnetate ([ 99m Tc]NaTcO 4) Parathyroid Scintigraphy Clinical Parathyroid Clinical Approach to Hyperparathyroidism Clinical Use of Parathyroid Imaging Persistent or Recurrent Hyperparathyroidism Secondary and Tertiary Hyperparathyroidism Neuroendocrine Tumors: Imaging Methods Radiopharmaceuticals ( 123 I or 131 I)-Meta-iodobenzylguanidine ( 123 I-MIBG or 131 I-MIBG) 111 In-Pentetreotide 18 F-Fluoro-Deoxyglucose (FDG) Other 18 F-Labeled PET Agents 68 Ga-Labeled Radiopharmaceuticals Neuroendocrine Tumors: Clinical Sympathochromaffin Tumors Enterochromaffin (Carcinoid) Tumors Gastro-Entero-Pancreatic (GEP) Tumors Medullary Thyroid Cancer Congenital Hyperinsulinism References 21: Lymphomas and Lymphoproliferative Disorders Methods 67 Ga-Gallium Scan Radiopharmaceutical Gallium Scan 18 F-FDG PET and 18 F-FDG PET/CT Radiopharmaceutical 18 F-FDG PET and PET/CT Clinical Hodgkin’s Disease Staging Response to Therapy Follow-up Surveillance Non-Hodgkin Lymphoma Staging Response to Therapy and Follow-Up Posttransplantation and Immunodeficiency-Related Lymphoproliferative Disorders Staging and Follow-up Imaging Non-neoplastic Syndromes of Lymphadenopathy References 22: Functional Imaging of Pediatric Musculoskeletal Tumors Methods Osteosarcoma Clinical Diagnosing and Staging of Osteosarcoma Osteosarcoma Response to Therapy Identifying Osteosarcoma Recurrence Ewing Sarcoma Clinical Diagnosis and Staging Ewing Sarcomas Response to Therapy of Ewing Sarcoma Imaging Recurrence of Ewing Sarcoma Rhabdomyosarcoma Clinical FDG PET of Rhabdomyosarcoma References 23: Solid Tumors in Childhood Tumors of Early Childhood Wilms’ Tumor Non-Wilms’ Renal Tumors Hepatoblastoma and Hepatocellular Carcinoma Retinoblastoma Germ Cell Tumors of Childhood Non-rhabdomyosarcoma Soft Tissue Sarcoma Spindle Cell Tumors Synovial Sarcomas Dermatofibrosarcoma Protuberans (DP) Inflammatory Myofibroblastic Tumors Malignant Peripheral Nerve Sheath Tumors Others Small Round Cell Tumors Desmoplastic Small Round Cell Tumors Clear-Cell Sarcoma Extraskeletal Myxoid Chondrosarcoma Malignant Rhabdoid Tumors (See Malignant Rhabdoid Tumor of the Kidney) Epithelioid Tumors Epithelioid Sarcoma Alveolar Soft Part Sarcoma Myxoid Tumor Unclassified/Undifferentiated Sarcoma Gastrointestinal Stromal Tumors Langerhans Cell Histiocytosis Neurofibromatosis Type 1 Epithelial Neoplasms and Malignant Melanoma Adrenocortical Carcinoma Nasopharyngeal Carcinoma Melanoma References 24: Infection and Inflammation Tracers Methylene Diphosphonate (MDP) Gallium-67 Labeled Leukocytes 18 F-Fluorodeoxyglucose Indications Opportunistic Infection Fever of Unknown Origin Inflammatory Bowel Disease Musculoskeletal Infection Osteomyelitis Subperiosteal Abscess Septic Arthritis Chronic Recurrent Multifocal Osteomyelitis Conclusions References 25: Pediatric Molecular Imaging Molecular Imaging Targets Molecular Imaging Techniques Ultrasound Optical Imaging Photoacoustic Imaging Computed Tomography (CT) Single-Photon Emission Computed Tomography (SPECT) Positron Emission Tomography (PET) and PET/CT Magnetic Resonance (MR) Imaging and PET/MR Clinical Molecular Imaging Applications with Future Perspectives Diagnostic Imaging Biomarkers Prognostic Imaging Biomarkers Predictive Biomarkers Biomarkers of Therapy Response Biomarkers of Disease Recurrence References 26: Combined PET/MRI in Childhood Basic Principles of Multimodality Imaging Image Fusion Image Presentation PET and MRI in Pediatric Oncology Neuroblastoma PET in Pediatric Neuroblastoma MRI in Pediatric Neuroblastoma Soft Tissue Sarcoma PET in Pediatric Sarcomas MRI in Pediatric Sarcomas Lymphoma PET in Pediatric Lymphoma MRI in Pediatric Lymphoma Histiocytosis PET in Pediatric Histiocytosis MRI in Pediatric Histiocytosis Combined PET/MRI in Clinical Practice First Experience with Simultaneous PET/MRI References 27: Physical Aspects of Pediatric Nuclear Medicine Imaging Challenges in Pediatric Imaging Planar Imaging Acquisition Instrumentation Collimation Choice of Parallel-Hole Collimator Magnification Collimation Data Analysis and Image Processing SPECT Acquisition Instrumentation Reconstruction Hybrid SPECT/CT Imaging PET/CT Acquisition Instrumentation Reconstruction PET-MR PET-MR Instrumentation MR-Based Attenuation Correction MR-Based Motion Correction Summary References 28: Radiation Exposures Dose Calculations Specialized Kinetic Models Effective Dose Anthropomorphic Models (Phantoms) Standardized Radiopharmaceutical Dose Estimates The Pregnant Patient Other Sources of Exposure References 29: Radiation Protection in Pediatric Nuclear Medicine Radiation Safety Roles and Responsibilities Radiation Safety Management Commitment and Structure Licensing General Guidelines Radiation Safety Committee Radiation Safety Officer Authorized Users Training Occupational Dose External Internal Dose Limits for Family Members Surveys and Monitoring Effluents Waste 10 CFR 35.1000 Procedures Radiation Protection Principles Time, Distance, and Shielding Time Distance Shielding ALARA Other Principles of Protection Pregnancy Instrumentation Patient and Family Safety References 30: Radiation Risk Effects of Radiation Exposure Radiobiologic Consequences Epidemiologic Studies Low-Dose and Low-Dose-Rate Exposure Explaining the Risks to Others Effective Dose Institutional Review Boards Patients and Their Families Conclusion References 31: Dose Optimization in Pediatric Nuclear Medicine Radiopharmaceutical Administered Activities Appropriateness of Clinical Indications, Utilization Criteria, Sequencing of Studies Pulmonary Aspiration and the Salivagram Evaluating the Skeletal Origin of Back and Extremity Pain Optimization of Imaging Protocols: Acquisition and Display Application of Advanced Image Processing Instrumentation Instrumentation, Adaptation, Collimator Use, Detectors (See also Chap. 27) Reduction of CT Exposure Education and Communication References Index