Radionuclide Imaging of Musculoskeletal Disorders in Children

  • Ariane Boubaker


Bone scintigraphy (BS) with 99mTc-labeled diphosphonates (99mTc-DPD) is the second most common nuclear medicine procedure performed in children and adolescents after renography. Common indications are suspicion of infections/inflammations, trauma, and tumors. BS is a simple and non-invasive procedure and does not need special preparation [1, 2, 3]. Cooperation of the child and parents can be easily obtained by a trained staff. A dedicated examination room and the use of distraction techniques (videos, music, and books) will work efficiently for patient immobilization during the acquisition. A proper time schedule with late acquisition performed after feeding and during the normal daytime sleeping period will allow infants and children to be examined without sedation. Local anesthetic cream should be applied at least 45 min before injection and the child should be encouraged to drink, especially between contrast injection and late imaging, to increase spontaneous voiding and lower radiation burden. A high-quality examination is mandatory and can be obtained by having the child lie directly on the collimator of the camera.


Single Photon Emission Compute Tomography Bone Metastasis Fibrous Dysplasia Reflex Sympathetic Dystrophy Primary Bone Tumor 
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  1. 1.
    Hahn K, Fischer S, Colarhina P et al (2001) Guidelines for bone scintigraphy in children. Eur J Nucl Med 28:BP42–47PubMedGoogle Scholar
  2. 2.
    Nadel HR, Stilwell ME (2001) Nuclear medicine topics in pediatric musculoskeletal disease. Radiol Clin North Am 39:619–651CrossRefPubMedGoogle Scholar
  3. 3.
    Nadel HR (2007) Bone scan update. Semin Nucl Med 37:332–339.CrossRefPubMedGoogle Scholar
  4. 4.
    Connolly LP, Treves ST, Connolly SA et al (1998) Pediatric skeletal scintigraphy: applications of pinhole magnification. Radiographics 18:341–354PubMedGoogle Scholar
  5. 5.
    Ferroni A (2007) Epidemiology and bacteriological diagnosis of paediatric acute osteoarticular infections. Arch Pediatr 14:S91–96CrossRefPubMedGoogle Scholar
  6. 6.
    Frank G, Mahoney HM, Eppes SC (2005) Musculoskeletal infections in children. Pediatr Clin North Am 52:1083–1106CrossRefPubMedGoogle Scholar
  7. 7.
    Rasmont Q, Yombi JC, van der Linden D, Docquier P (2008) Osteoarticular infections in Belgian children: a survey of clinical, biological, radiological and microbiological data. Acta Orthop Belg 74:374–385PubMedGoogle Scholar
  8. 8.
    Riise 0R, Kirkhus E, Handeland KS et al (2008) Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study. BMC Pediatr 20:8–45Google Scholar
  9. 9.
    Azoulay ØR, Alison M, Sekkal A et al (2007) Imaging of child osteoarticular infections. Arch Pediatr 14:S113–121CrossRefPubMedGoogle Scholar
  10. 10.
    Connolly LP, Connolly SA (2003) Skeletal scintigraphy in the multimodality assessment of young children with acute skeletal symptoms. Clin Nucl Med 28:746–754CrossRefPubMedGoogle Scholar
  11. 11.
    Do TT (2000) Transient synovitis as a cause of painful limps in children. Curr Opin Pediatr 12:48–51CrossRefPubMedGoogle Scholar
  12. 12.
    Stumpe KDM, Strobel K (2009) Osteomyelitis and arthritis. Semin Nucl Med 39:27–35CrossRefPubMedGoogle Scholar
  13. 13.
    Cheow HK, Set P, Robinson S et al (2008) The role of bone scan in the diagnosis of carpal fracture in children. J Pediatr Orthop 17:165–170Google Scholar
  14. 14.
    Bajelidze G, Belthur MV, Littleton AG, Dabney KW, Miller F (2008) Diagnostic evaluation using whole-body technetium bone scan in children with cerebral palsy. J Pediatr Orthop 28:112–117PubMedGoogle Scholar
  15. 15.
    Mandelstam SA, Cook D, Fitzgerald M, Ditchfield MR (2003) Complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse. Arch Dis Child 88:387–390CrossRefPubMedGoogle Scholar
  16. 16.
    Kemp AM, Dunstan F, Harison S, Morris S, Mann M, Rolfe K, et al (2008) Patterns of skeletal fractures in child abuse: systematic review. BMJ 337:859–862CrossRefGoogle Scholar
  17. 17.
    Van der Wall H, Storey G, Frater C, Murray P (2001) Importance of positioning and technical factors in anatomic localization of sporting injuries in scintigraphic imaging. Semin Nucl Med 31:17–27CrossRefPubMedGoogle Scholar
  18. 18.
    Greenspan A, Remagen W Knochentumoren. Differentialdiagnose in Radiologie und Pathologie (2000). Georg Thieme Verlag, Stuttgart New YorkGoogle Scholar
  19. 19.
    Davies AM (2001) Imaging in skeletal paediatric oncology. Eur J Radiol 37:79–94CrossRefPubMedGoogle Scholar
  20. 20.
    Focacci C, Lattanzi R, Iadeluca ML, Campioni P (1998) Nuclear medicine in primary bone tumors. Eur J Radiol 27:S123–S131CrossRefPubMedGoogle Scholar
  21. 21.
    Kaste SC, Rodriguez-Galindo C, McCarville ME, Shulkin BL (2007) PET-CT in pediatric Langerhans cell histiocytosis. Pediatr Radiol 37:615–622CrossRefPubMedGoogle Scholar
  22. 22.
    Goodin GS, Shulkin BL, Kaufman RA, McCarville MB (2006) PET/CT characterisation of fibroosseous defects in children: 18F-FDG uptake can mimic metastatic disease. AJR Am J Roentgenol 187:1124–1128CrossRefPubMedGoogle Scholar
  23. 23.
    Even-Sapir E, Mishani E, Flusser G, Metser U (2007) 18F-fluoride positron emission tomography and positron emission tomography/computed tomography. Semin Nucl Med 37:462–469CrossRefPubMedGoogle Scholar
  24. 24.
    Meyer JS, Nadel HR, Marina N et al (2008) Imaging guidelines for children with Ewing sarcoma and osteosarcoma: a report from the Children’s Oncology Group bone tumor committee. Pediatr Blood Cancer 51:163–170CrossRefPubMedGoogle Scholar
  25. 25.
    Jadvar H, Alavi A, Mavi A, Shulkin B (2005) PET in pediatric disease. Radiol Clin N Am 43:135–152CrossRefPubMedGoogle Scholar
  26. 26.
    Jadvar H, Connolly LP, Fahey FH, Shulkin B (2007) PET and PET/CT in pediatric oncology. Semin Nucl Med 37:316–331CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • Ariane Boubaker
    • 1
  1. 1.Service de Medicine NucléaireCentre Hospitalier Universitaire VaudoisLausanneSwitzerland

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