Objectives To evaluate the prevalence and factors affecting the detection of active brown adipose tissue (BAT) in children and adolescents using18 F-fluorodeoxyglucose positron emission tomography. ...Study design A total of 385 positron emission tomography scans performed for various oncologic indications in 172 patients aged 5-21 years were reviewed. BAT activity was detected by visual inspection as present or absent in the neck, thorax, and abdomen based on its well-characterized and typical appearance and then quantified by comparing the18 F-fluorodeoxyglucose activity in the cervical-supraclavicular depots with that measured in the liver. Clinical indices were recorded. Results The BAT detection rate was not significantly different between boys and girls (43.3% vs 45.3%). BAT activity was found most often in the cervical-supraclavicular depots. The highest percentage of patients with detectable BAT and the highest BAT/liver activity were in the 13- to 14.99-year age group in both males and females ( P = .005). Body mass index percentile correlated inversely with BAT activity ( P = .012). BAT activity did not correlate with outdoor temperature or clinical diagnosis. Conclusion Under typical clinical imaging conditions, BAT is detected more frequently in children than in adults. BAT activity increases from childhood into adolescence, when it is detected in almost half of patients, and it correlates inversely with obesity, suggesting that BAT may play a prominent role in pediatric metabolism.
We reviewed the safety of nuclear diuretic renography with furosemide in patients with sulfonamide allergies. The electronic health record was used to uncover any drug effects reported within 30 days ...of diuretic renograms performed between January 2009 and December 2015.
Eighty-three of 1103 (7.5%) diuretic renograms were performed on patients with sulfonamide allergies. Two instances of minor rash occurred. No serious reactions occurred. Furosemide is associated with an extremely low risk of minor reactions in patients with sulfonamide allergies.
PET and PET/CT in Pediatric Oncology Jadvar, Hossein, MD, PhD, MPH, MBA; Connolly, Leonard P., MD; Fahey, Frederic H., DSc ...
Seminars in nuclear medicine,
09/2007, Letnik:
37, Številka:
5
Journal Article
Recenzirano
18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) and FDG-PET/computed tomography (CT) are becoming increasingly important imaging tools in the noninvasive evaluation and monitoring of ...children with known or suspected malignant diseases. In this review, we discuss the preparation of children undergoing PET studies and review radiation dosimetry and its implications for family and caregivers. We review the normal distribution of18 F-fluorodeoxyglucose (FDG) in children, common variations of the normal distribution, and various artifacts that may arise. We show that most tumors in children accumulate and retain FDG, allowing high-quality images of their distribution and pathophysiology. We explore the use of FDG-PET in the study of children with the more common malignancies, such as brain neoplasms and lymphomas, and the less-common tumors, including neuroblastomas, bone and soft-tissue sarcomas, Wilms’ tumors, and hepatoblastomas. For comparison, other PET tracers are included because they have been applied in pediatric oncology. Multiple multicenter trials are underway that use FDG-PET in the management of children with neoplastic disease; these studies should give us greater insight into the impact FDG-PET can make in their care. PET is emerging as an important diagnostic imaging tool in the evaluation of pediatric cancers. The recent advent of dual-modality PET-computed tomography (PET/CT) imaging systems has added unprecedented diagnostic capability by revealing the precise anatomical localization of metabolic information and metabolic characterization of normal and abnormal structures. The use of CT transmission scanning for attenuation correction has shortened the total acquisition time, which is an especially desirable attribute in pediatric imaging. Moreover, expansion of the regional distribution of the most common PET radiotracer, FDG, and the introduction of mobile PET units have greatly increased access to this powerful diagnostic imaging technology. Here, we review the clinical applications of PET and PET/CT in pediatric oncology. General considerations in patient preparation and radiation dosimetry will be discussed.
The style and tone of the writing in Radiology has changed over the years since its first publication in 1923. Many of the tonal changes have occurred transiently and likely in relation to political ...and professional issues in play at a particular time. Others represent more consistent trends in the evolution of the professional writing style. In this report, we analyze the tone of the editorial content from 1923 to 2013 in a historical context as well as progressive changes in readability parameters involving both editorial and technical content.
We analyzed our experience with MRI of pelvic acute hematogenous osteomyelitis (AHO) to address the following questions: What does MRI reveal about bone involvement? How often are fluid collections ...indicative of abscess shown? Are clinical parameters predictive of the cases in which MRI would be more beneficial?
We retrospectively reviewed the imaging studies and medical records from the past 5 years of 38 children ranging in age from 25 to 211 months who were diagnosed with pelvic osteomyelitis using MRI. Statistical analysis of demographic and clinical variables was compared between patients with an abscess (n = 21) and those without (n = 17) who were identified on MRI.
Osteomyelitis involved metaphyseal equivalent sites in every case (n = 38), with single bone involvement in 24 (63%) and contiguous bone involvement in the remaining 14 (37%). Fluid collections indicative of an abscess were seen in 21 cases (55%), and abscess drainage was performed in 10 (26%). Univariate analysis of demographic and clinical variables between patients with and without an abscess indicated no significant differences for any variable except erythrocyte sedimentation rate (ESR) (74 +/- 19 vs 56 +/- 24 mm/h; p< 0.05, Student's t test).
Childhood pelvic AHO is relatively uncommon and produces variable signs and symptoms that are often attributed to another process. The results of our study show the ability of MRI to provide additional information that affected patient management in cases of pelvic abscess. We therefore advocate the use of MRI as the imaging technique of choice for any child suspected of having pelvic AHO.
PURPOSE:Skeletal positron emission tomography (PET) with fluorine-18 (F) sodium fluoride (F NaF) is an alternative to technetium-99m (Tc)methylene diphosphonate (MDP) scintigraphy. Experience with ...pediatric PET is sparse, primarily in oncology. This study assesses the role of F NaF in evaluating young patients with back pain.
METHODS:Ninety-four F NaF PET scans were performed in 94 patients (27 males, 67 females; mean age, 15 years; range, 4-26 years) with back pain. Three-dimensional PET acquisition was performed 30 minutes after administration of F NaF (2.1 MBq/kg; maximum, 148 MBq). Radiation doses are presented for F NaF and Tc MDP.
RESULTS:F NaF PET revealed a possible cause of back pain in 55% (52/94). Fifteen patients had 2 or more potential sources of back pain. Diagnoses by PET were pars interarticularis/pedicle stress (34%), spinous process injury (16%), vertebral body ring apophyseal injury (14%), stress at a transitional vertebra-sacral articulation (7%), and sacroiliac joint inflammation/stress (3%). Comparing F NaF PET with Tc MDP scintigraphy, time between injection and scanning was shorter (0.5 hours vs 3 hours), radiation dosimetry was similar (3.5 mGy vs 2.8 mGy effective dose for a 55-kg patient for F NaF and Tc MDP, respectively), and cost of radiopharmaceutical was higher.
CONCLUSIONS:F NaF bone PET can detect a variety of skeletal abnormalities in young patients with back pain. Relative to Tc MDP, images are of higher resolution. Total time from tracer administration to completion is shorter, and radiation dosimetry is similar. Higher cost for F NaF may be offset by enhanced patient throughput.
Objectives/Hypothesis: To study the presentation, management, and long‐term outcome of children presenting with lingual thyroid.
Study Design: Institutional review board approved, retrospective study ...(1993–2004).
Methods: The study was conducted at a tertiary care pediatric medical center. The main outcomes measured were initial presentation, radiographic findings, endocrine evaluation, surgical outcome, pathologic features, complications, need for hormonal replacement.
Results: Four patients presented to the Department of Otolaryngology and Communications Enhancement, Children's Hospital Boston with lingual thyroid between 1993 and 2004. All patients were female, with an age range of 2 to 12 years (x = 6). All patients presented with a mass (1.4–3.5 cm) and most with respiratory or feeding difficulty. Magnetic resonance imaging was obtained in three patients and revealed a mass consistent with lingual thyroid. Thyroid scan confirmed the lingual thyroid as the only functioning thyroid in all four patients. None of the patients responded to hormonal replacement, and all underwent surgical excision of the mass. Surgical approach included midline glossotomy (n = 2) and CO2 laser excision (n = 2). Pathologic evaluation confirmed lingual thyroid in all four patients. No evidence of malignancy was seen in any patient. All four patients require lifelong hormonal replacement.
Conclusions: Lingual thyroid is a rare condition, with an incidence of 1:100,000. This infrequent congenital anomaly is often asymptomatic until a pathologic stress such as systemic disease or physiologic stress such as puberty causes enlargement of the ectopic tissue, leading to dysphagia, dysphonia, and dyspnea. The work‐up should include routine blood work including thyroid function tests thyrotropin, thyroxine, and thyroid hormone binding ratio; iodine thyroid scintigraphy; and computerized tomography or magnetic resonance imaging. The majority of patients require surgical excision of the symptomatic mass and, in case of absence of orthotopic thyroid tissue, long‐term thyroid hormone replacement.
The emergence of MRI has challenged the long-standing primacy of skeletal scintigraphy in pediatric cases of suspected acute hematogenous osteomyelitis (AHO) with nondiagnostic radiographs. This ...study evaluated a strategy in which skeletal scintigraphy is the primary and MRI a supplemental test.
We reviewed the records of 213 children (age range, 8 mo-18 y; mean age, 67 mo) with musculoskeletal symptoms and nondiagnostic radiographs who were referred for skeletal scintigraphy because of the possibility of AHO. MRI was performed when diagnostic uncertainty persisted after skeletal scintigraphy or when abscess was suspected.
Diagnosis was made using skeletal scintigraphy without referral for MRI in 179 (84%) of the children, including 79 (92%) of 86 with a final diagnosis of AHO. In no instance was the diagnosis of AHO indicated only by MRI. Treatment and diagnosis were accomplished without referral for MRI in 146 (69%) of all cases and 46 (53%) of the AHO cases. Abscesses that required drainage were found in 3 (6%) of 48 cases of major-long-bone AHO. Each of these 3 had exhibited a slow therapeutic response before MRI. Drainable abscesses were found in 5 (20%) of 25 cases affecting the pelvis, which was the other preponderant location of AHO. These were found with pelvic foci both when MRI was performed at diagnosis and when MRI was performed during treatment.
An imaging strategy in which skeletal scintigraphy is the first test used when AHO is suspected but radiographs are negative remains highly effective. This approach can be most strongly advocated when symptoms are poorly localized or are localized to major long bones. MRI should be performed after skeletal scintigraphy shows major-long-bone AHO if treatment response is slow. Skeletal scintigraphy is also an appropriate first test for suspected radiographically occult pelvic AHO. Because of the association of abscesses with pelvic AHO, however, the use of MRI should be strongly considered after pelvic AHO is detected, and MRI might be substituted diagnostically for skeletal scintigraphy when symptoms are well localized to the pelvis.
Lumbosacral transitional vertebrae can alter the biomechanics of weight transfer at the affected spinal segment. Low-back pain may result. This study assessed what skeletal scintigraphy reveals about ...stress associated with a lumbosacral transitional vertebra in young patients with low-back pain.
The study population included 48 patients (30 male, 18 female; age range, 6-19 y; mean age, 15.7 y) with low-back pain and a lumbosacral transitional vertebra. Skeletal scintigraphy was correlated with plain radiographs in all, CT in 12, and MRI in 11.
High uptake was shown at the articulation between the transverse process of a lumbosacral transitional vertebra and the sacrum in 39 (81%) of the patients. In 23 (59%) of the 39 patients with high uptake, this finding was shown only by SPECT. In 13 (81%) of the 16 for which the high uptake was shown by planar imaging, the anterior projection was more valuable than the posterior projection. In 9 (23%) of the 39 patients with high uptake at the transverse-sacral articulation, the lumbosacral transitional vertebra had not been noted in a radiographic report before skeletal scintigraphy but was identified through reevaluation or repetition of radiographs after skeletal scintigraphy. Radiographs showed sclerosis along the transverse-sacral articulation in only 8 (21%) of the 39 patients with high uptake. Findings indicating stress or motion at the joint were shown by CT in 6 (55%) of 11 and by MRI in 5 (63%) of 8 patients with high uptake at the transverse-sacral articulation who underwent these examinations.
Skeletal scintigraphy often indicates stress at the transverse-sacral articulation of young patients with low-back pain and a lumbosacral transitional vertebra. Showing evidence of stress is best accomplished using SPECT. Changes are usually not radiographically evident, but there is a trend for MRI and CT to show findings that imply stress or motion at the articulation. The unique ability of skeletal scintigraphy to provide this physiologic information supports its use in these patients.
Rib Stress Fractures Connolly, Leonard P; Connolly, Susan A
Clinical nuclear medicine,
2004-October, 2004-Oct, 2004-10-00, 20041001, Letnik:
29, Številka:
10
Journal Article
Recenzirano
The ribs are an uncommon site of stress fracture. Typical locations are the first rib anterolaterally, the fourth through ninth ribs laterally and posterolaterally, and the posteromedial upper ribs. ...Muscular forces are predominantly responsible for these fractures. This article reviews the mechanisms of injury in various activities and illustrates the scintigraphic appearance of rib stress fractures.
