Skeletal scintigraphy with SPECT/CT in benign pediatric bone conditions

Abstract

Benign bone diseases present an ongoing challenge for pediatricians. Most of them are not life threatening, but may be associated with significant morbidity. Benign space occupying lesions are a source of pain and/or pathological fractures. Their symptoms may raise concern for malignancy and require a complex diagnostic workup. Late or inadequate treatment of bone infections may result in bone and joint destruction and lifelong functional impairment especially in young children. Bone damage due to altered blood supply or due to minor trauma can be difficult to identify. MRI is a cornerstone in modern assessment of pediatric bone disease, but bone scintigraphy remains a useful tool in this clinical field. Unlike MRI, bone scans are widely available, provide whole body rather than focused exploration, are less affected by metallic implants or devices and combined with CT in hybrid SPECT/CT systems, allow visualization of bone morphology and metabolism in a single imaging session. The clinical indication and imaging technique of skeletal SPECT/CT in children are still evolving although the benefit of this technique in evaluation of children with bone pain and/or serendipitously found bone lesions seems ascertained. Improvements in gamma camera technology allow the obtaining of high quality images with either shorter acquisition times and /or reduced radiopharmaceutical administered activities. Sedation is required much less for bone scans than for MRI.