Table Of ContentPediatric Nuclear
Medicine/PET
Third Edition
S.T. Treves,
MD
Editor
Pediatric Nuclear
Medicine/PET
Third Edition
With a Foreword by George A.Taylor,MD
S.T.Treves,MD
Chief
Division of Nuclear Medicine
Children’s Hospital Boston
Professor of Radiology
Harvard Medical School
Boston,MA 02115
USA
Library of Congress Control Number:200690202
ISBN-10:0-387-32321-X e-ISBN-10:0-387-32322-8
ISBN-13:978-0387-32321-3 e-ISBN-13:978-0387-32322-0
Printed on acid-free paper.
© 2007 Springer Science+Business Media,LLC
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To my wife,Nancy,
my children,Erik,Alex,Blake,
and Olivia
and my parents,Catherine and Elias
Foreword
This third edition of Pediatric Nuclear Medicine/PET comes at a
very propitious time. In the decade since the last edition was
published, we have had major successes in decoding the human
genome, technological developments in image processing, image
quantification, and a new understanding of the molecular events
triggering normal and abnormal cellular processes.These advances
have resulted in a revolution in medical imaging.We are well into
the transformation from a qualitative, descriptive discipline
involved in imaging anatomic structures to one that is more
quantitative and much more capable of imaging physiologic and
cellular processes and displaying them in four dimensions (three-
dimensional images over time).
The field of nuclear medicine has benefited from these transfor-
mational changes, and its role remains quite strong in pediatric
imaging.Technical innovations have increased our ability to visu-
alize functional,physiologic processes more quickly,more specifi-
cally, and with more anatomic certainty than ever before. The
impact of this new knowledge on the clinical practice of pediatric
nuclear medicine has been substantial.Some imaging studies per-
formed commonly in the recent past are no longer used clinically,
such as dacryoscintigraphy and scrotal scintigraphy. Despite the
high degree of accuracy for distinguishing between inflammatory
and ischemic conditions, scrotal scintigraphy has been essentially
replaced by color Doppler sonography.As some techniques have
faded,others have been added to the nuclear medicine armamen-
tarium. Single photon emission computed tomography (SPECT)
has become much more prevalent,and tissue-specific imaging with
metaiodobenzylguanidine (MIBG) for neuroblastoma and ses-
tamibi for myocardial perfusion studies have been some of the
major improvements in the traditional practice of nuclear medi-
cine.These have been incremental changes in existing technology.
The most significant development has been the dissemination of
positron emission tomography (PET) into pediatric practice.At the
time of the last edition, probably only one PET scanner had any
major pediatric use in the United States.As of this writing,several
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viii Foreword
pediatric centers,including ours,have installed PET scanners ded-
icated primarily to imaging children.
As a pediatric radiologist,I have seen the impact of PET on the
clinical care of children with solid tumors. It is very humbling to
interpret ill-defined nodules on a contrast-enhanced computed
tomography (CT) of the abdomen as unopacified loops of bowel,
only to have them practically jump off the monitor screen as
PET-avid lesions. Our imaging practice has had to change to
accommodate the powerful nature of these new images.
This third edition of Pediatric Nuclear Medicine/PET incorpo-
rates the major advances that have been made in nuclear medicine
in the recent past.The book is streamlined, up to date, and very
readable.Chapters on brain and cerebrospinal fluid imaging have
been combined;chapters on bone scintigraphy,Legg-Calvé-Perthes
syndrome,evaluation of growth centers,and mandibular asymme-
try have been consolidated into an excellent chapter on bone dis-
orders;and chapters on scrotal scintigraphy and dacryoscintigraphy
have been replaced with new,more focused chapters on PET and
oncologic imaging.Each chapter is organized around the concepts
of applicable radionuclides, imaging techniques, clinical applica-
tions, and specific disease entities.There is a significant effort to
include correlative imaging in many of the chapters, and image
fusion is displayed liberally throughout the book.
Pediatric Nuclear Medicine/PETwill continue to be the bible of
nuclear imaging in children.It will serve as the standard reference
for medical students,residents,nuclear medicine physicians,tech-
nologists, and referring clinicians on how to perform and use
radioactive tracer studies in the optimal care of sick children.
George A.Taylor,MD
John A.Kirkpatrick Professor of Radiology (Pediatrics)
Radiologist-in-Chief,Children’s Hospital
Boston,MA
Preface
The second edition of Pediatric Nuclear Medicine was published
just over 10 years ago. This third edition is entitled Pediatric
Nuclear Medicine/PET.This book reflects advances in the technol-
ogy and applications of classic pediatric nuclear medicine that have
occurred during the past decade or so.Early pediatric experience
with positron emission tomography (PET) has been included in
the appropriate chapters,and there is a new chapter covering the
physics and technical aspects of PET as they apply to pediatric
patients.With very few exceptions, many of the chapters in Pedi-
atric Nuclear Medicine/PEThave been either significantly updated
or rewritten entirely.
This book largely reflects the experience at Children’s Hospital
Boston. In addition, I am very fortunate that the work includes
contributions from several outstanding colleagues from other
institutions.
Following the first chapter that covers general aspects of pedi-
atric nuclear medicine,the work is organized according to organs
and systems including the brain and cerebrospinal fluid, thyroid,
calculations of I-131 therapy doses,pulmonary system,cardiovas-
cular system,gastroesophageal reflux and aspiration,gastrointesti-
nal bleeding, liver and spleen, kidneys, vesicoureteral reflux,
glomerular filtration rate,bone,oncology,infection and inflamma-
tion,magnification,single photon emission computed tomography
(SPECT),PET,radiation risk,and internal dosimetry.
As in the prior editions, this book concentrates specifically on
pediatric aspects of nuclear medicine;it is not intended to provide
a multimodality review of pediatric imaging.For that type of per-
spective,the reader is directed to textbooks that cover all aspects
of pediatric imaging. However, because of the relatively recent
introduction of hybrid systems [PET/computed tomography (CT),
SPECT/CT] and the significant improvements in image registration
and fusion, several clinical examples in this text include image
correlations.
This book includes an accompanying DVD, which allows the
reader to review over 130 pediatric nuclear medicine cases.These
cases are from the Division of Nuclear Medicine, Children’s
Hospital Boston.
ix
x Preface
Each case is logically organized to illustrate specific applications,
techniques, and teaching points that nuclear medicine physicians
are likely to encounter in daily practice, including multimodality
image fusion in pediatric patients.
The DVD provides physicians who would like to become fami-
liar with a view of the full scope of pediatric nuclear medicine appli-
cations, but who are not able to spend much time in a pediatric
nuclear medicine unit.
I hope that this book will be helpful to physicians,technologists,
and students involved in the care of pediatric patients.
S.T.Treves,MD
Acknowledgments
I would like to thank many friends and colleagues who in one way
or another have contributed to make this third edition of Pediatric
Nuclear Medicine/PET a reality.
I would like to thank Chris Durall for his great help in the pre-
paration of the manuscript through its many drafts and revisions,
and for helping organize the work and communications among the
contributors, the editor, and the publisher. His meticulous and
consistent attention to detail and commitment to this project has
made my work more bearable. Jennifer Duane assisted with
various communications with authors.Royal Davis,(CNMT),pro-
vided personnel and organizational leadership and ensured the
smooth technical operations of the Division of Nuclear Medicine.
Many technologists contributed expert technical assistance,excel-
lent imaging, and computer application skills. Their dedication,
care, patience, and compassion in dealing with our pediatric
patients cannot be acknowledged enough.These included Diane
Itrato, Tracy Tetrault, Vicky Kourmouzi, Erin Kistler, Joanne
Olofson, and Steven Laffin. Our nurses, Valerie Dinan, Maura
Heckmann,and Dell Spangler,have provided expert care,comfort,
and compassion to many children being examined in our division.
Our child life specialist,Tricia Ashe,participated in the preparation
of patients and parents by providing explanations, educational
materials,appropriate toys and other materials to help make their
experience a positive one.Karl Mitchell provided excellent clinical
computer software programs for display and analysis of several
clinical applications, as well as an excellent systems integration
environment. He also provided invaluable assistance in clinical
database research, image registration, and fusion. Fred Fahey,
DSc, provided excellent nuclear medicine and positron emission
tomography (PET) physics support and served as reviewer of
chapters in the book as well.Alan Packard, PhD, contributed to
the text and reviewed chapters.Miriam Geller and Allison Clapp
provided expert literature research support.I would like to thank
my colleagues, the referring physicians, for trusting us with their
patients.I would like to thank all the members of the Department
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