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1.
Pediatr Radiol ; 53(12): 2424-2433, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37740781

RESUMO

BACKGROUND: The location and proximity to the spinal cord in spinal osteoid osteoma can increase the likelihood of an incomplete resection. Intraoperative bone scintigraphy (IOBS) can be used to verify location and complete surgical resection. OBJECTIVE: To review our experience using IOBS for resection of intraspinal osteoid osteoma. METHODS: IRB approved, retrospective review of IOBS-guided resection over 10 years. Patients underwent injection of 200 uCi/kg (1-20 mCi) 99mTc-MDP 3-4 h prior surgery. Portable single-headed gamma camera equipped with a pinhole collimator (3- or 4-mm aperture) was used. Images were obtained pre-operatively, at the start of the procedure, and intraoperatively. Operative notes were reviewed. Evaluation of recurrence and clinical follow-up was performed. RESULTS: Twenty IOBS-guided resections were performed in 18 patients (median age 13.5 years, 6-22 years, 12 males). Size ranged 5-16 mm, with 38.9% (7/18) cervical, 22.2% (4/18) thoracic, 22.2% (4/18) lumbar, and 16.7% (3/18) sacral. In all cases, IOBS was able to localize the lesion. After suspected total excision, IOBS altered the surgical plan in 75% of cases (15/20), showing residual activity prompting further resection. Median length of follow-up was 6 months (range 1-156 months) with 90% (18/20) showing complete resection without recurrence. Two patients had osteoid osteoma recurrence at 7 and 10 months following the original resection, requiring re-intervention. CONCLUSIONS: IOBS is a useful tool for real-time localization and assessment of spinal osteoid osteoma resection. In all cases, IOBS was able to localize the lesion and changed surgical planning in 75% of cases. Ninety percent of patients achieved complete resection and remain recurrence free.


Assuntos
Neoplasias Ósseas , Osteoma Osteoide , Neoplasias da Coluna Vertebral , Adolescente , Humanos , Masculino , Neoplasias Ósseas/diagnóstico por imagem , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/cirurgia , Cintilografia , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/patologia , Feminino , Criança , Adulto Jovem
3.
Am J Gastroenterol ; 115(11): 1830-1839, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33156102

RESUMO

INTRODUCTION: Adult standards for gastric emptying scintigraphy, including the type of meal and range of normative values for percent gastric emptying, are routinely used in pediatric practice, but to date have not been validated. The purpose of this study is to determine whether the use of adult criteria for gastric emptying scintigraphy is valid for children and whether alternative nonstandard meals can also be offered based on these criteria. METHODS: This retrospective study analyzed patients (n = 1,151 total) who underwent solid-phase gastric emptying scintigraphy. Patients were stratified into normal and delayed gastric emptying cohorts based on adult criteria, i.e., with normal gastric emptying defined as ≤10% gastric retention at 4 hours. Patients were further stratified based on the type of meal, namely complete or partial adult standard meals or alternative cheese-based meals. Percent gastric retention values at 1, 2, 3, and 4 hours were compared. RESULTS: The median (95% upper reference limit) percentage gastric retention values for the complete standard meal were 72% (93%) at 1 hour, 39% (65%) at 2 hours, 15% (33%) at 3 hours, and 6% (10 %) at 4 hours. By comparison, the values for cheese-based meals were 60% (87%) at 1 hour, 29% (61%) at 2 hours, 10% (30%) at 3 hours, and 5% (10%) at 4 hours. Consumption of at least 50% of the standard meal yielded similar retention percentages; 68% (89%) at 1 hour, 32% (57%) at 2 hours, 10% (29%) at 3 hours, and 5% (10%) at 4 hours. There were no significant age- or sex-specific differences using the adult criteria. DISCUSSION: The adult normative standards for gastric emptying scintigraphy are applicable for use in the pediatric population. These same standards can be also be applied to nonstandard meal options, including cheese-based alternative meals and partial standard meals.


Assuntos
Técnicas de Diagnóstico do Sistema Digestório , Esvaziamento Gástrico , Refeições , Cintilografia/métodos , Compostos Radiofarmacêuticos , Adolescente , Queijo , Criança , Ovos , Feminino , Alimentos , Humanos , Masculino , Valores de Referência , Adulto Jovem
4.
Pediatr Radiol ; 50(5): 689-697, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31993707

RESUMO

BACKGROUND: Gastric emptying scintigraphy is widely used in infants and children, but there is a lack of age-specific normative data. OBJECTIVE: The objectives of this retrospective study were: 1) to establish a range of gastric emptying of milk or formula as a surrogate for normal gastric emptying in infants and young children ≤5 years of age, and 2) to investigate the effects of patient age, feeding volume, feeding route and gastroesophageal reflux on gastric emptying. MATERIALS AND METHODS: The reports of 5,136 gastric emptying studies of children ≤5 years of age performed at Children's National Medical Center from January 1990 to August 2012 were reviewed. Demographic data, 1-h and 3-h gastric emptying values and gastroesophageal reflux status of all patients were stored in a database. Using stringent inclusion and exclusion criteria, the studies of patients as similar to healthy children as possible were selected for this study. RESULTS: The study group included 2,273 children (57% male) ages 0-59 months (median: 4.6 months). The median 1-h gastric emptying was 43% (interquartile range [IQR] 34-54%). The median 3-h gastric emptying was 91% (IQR 79-98%). Sixty-one percent of patients with 1-h gastric emptying value of <50% had 3-h gastric emptying ≥80%. Gastric emptying was significantly faster in children ≤6 months as compared with all older age groups. In each age group, the median gastric emptying decreased with increasing feeding volume. Gastric emptying was significantly faster in patients fed via combined nasogastric tube and oral routes as compared with those fed exclusively orally. There was no significant difference in gastric emptying of children with and without gastroesophageal reflux. CONCLUSION: Although there are statistically significant differences in gastric emptying based on age, volume and route of feeding, the data suggest that overall normal liquid gastric emptying in infants and children ≤5 years of age is ≥80% at 3 h. One-hour emptying measurements are not reliable for detecting delayed gastric emptying.


Assuntos
Esvaziamento Gástrico/fisiologia , Leite , Estômago/diagnóstico por imagem , Estômago/fisiologia , Fatores Etários , Animais , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Cintilografia/métodos , Estudos Retrospectivos
5.
Magn Reson Imaging Clin N Am ; 27(2): 387-407, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30910104

RESUMO

PET/MR imaging is an integrated imaging system that combines the high soft tissue resolution of MR imaging with the quantitative data obtained from PET into a single system. It is a relatively new imaging technique but with potential clinical use in pediatric oncologic and nononcologic processes in additional to its role in research. It is particularly relevant in pediatric patients due to reduced radiation burden compared with PET/CT and the ability to obtain exquisite functional and anatomic imaging in a single imaging session, thereby reducing the number of anesthesia/sedations. This review article focuses on the current as well as future applications of PET/MR imaging in pediatric imaging, including both oncologic and nononcologic indications.


Assuntos
Imageamento por Ressonância Magnética/métodos , Imagem Multimodal/métodos , Pediatria/métodos , Tomografia por Emissão de Pósitrons/métodos , Adolescente , Criança , Pré-Escolar , Humanos
6.
Pediatr Radiol ; 49(5): 663-677, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30535870

RESUMO

Technical and clinical aspects of esophageal transit scintigraphy in pediatric patients are reviewed via several illustrative cases that highlight its utility in evaluating primary and secondary esophageal motility disorders.


Assuntos
Transtornos da Motilidade Esofágica/diagnóstico por imagem , Cintilografia/métodos , Criança , Diagnóstico Diferencial , Humanos
7.
J Pediatr Gastroenterol Nutr ; 68(1): 68-73, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30256266

RESUMO

OBJECTIVES: Chronic acalculous cholecystitis (CAC) increasingly is being diagnosed as a cause of recurring biliary symptoms in children, but its clinical diagnosis remains challenging. The primary objective was to evaluate the utility of hepatocholescintigraphy in pediatric patients with suspected CAC. A secondary objective was to describe their clinical follow-up after diagnosis. METHODS: Medical records of patients (aged 9-20 years) who underwent hepatocholescintigraphy from February 2008 to January 2012 were reviewed. Patients with gallstones, and with ≤1 year of clinical follow-up, and studies without gallbladder (GB) stimulation were excluded. GB ejection fraction (GBEF) of <35% after sincalide or fatty meal (Lipomul) stimulation were considered abnormal. Diagnosis of CAC was based on histopathology after cholecystectomy. Patients with negative GB pathology, or complete resolution of symptoms without surgery, or alternative diagnoses for persistent symptoms were considered to not have CAC. RESULTS: Eighty-three patients formed the study group (median age 14.9 years), of which 81.9% were girls. Median duration of symptoms and clinical follow-up were 6 months and 2.9 years, respectively. Fifty-two patients had at least 1 study with sincalide and 36 patients had at least 1 study with Lipomul. Initial cholescintigraphy was 95.0% sensitive and 73.0% specific in diagnosing CAC, with a negative predictive value of 97.9%. Of the 31 patients with abnormal GBEF, 22 underwent cholecystectomy with improvement in pain in 72.7%, whereas all of the 9 without surgery improved. CONCLUSIONS: Hepatocholescintigraphy is useful for excluding CAC, although the clinical implications of an abnormal GBEF need to be further defined.


Assuntos
Colecistite Acalculosa/diagnóstico por imagem , Doenças da Vesícula Biliar/diagnóstico por imagem , Cintilografia/estatística & dados numéricos , Colecistite Acalculosa/complicações , Adolescente , Sistema Biliar/diagnóstico por imagem , Criança , Colecistectomia/métodos , Colecistectomia/estatística & dados numéricos , Doença Crônica , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Doenças da Vesícula Biliar/etiologia , Doenças da Vesícula Biliar/cirurgia , Humanos , Masculino , Valor Preditivo dos Testes , Cintilografia/métodos , Sensibilidade e Especificidade , Resultado do Tratamento , Adulto Jovem
8.
Pediatr Radiol ; 47(11): 1526-1538, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29043421

RESUMO

Duplication anomalies of the urinary collecting system are common and can be discovered and characterized with multiple imaging modalities. The embryology, imaging manifestations and clinical ramifications of duplicated ureters and renal collecting systems vary from a normal anatomical variant to urological pathology and are discussed and illustrated in this review.


Assuntos
Diagnóstico por Imagem/métodos , Sistema Urinário/anormalidades , Sistema Urinário/diagnóstico por imagem , Criança , Humanos , Sistema Urinário/embriologia
9.
Radiol Clin North Am ; 55(4): 803-844, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28601181

RESUMO

Pediatric nuclear medicine imaging presents unique challenges and requires a thorough understanding of the patients' developmental stages and physiology to optimize study protocols. This article provides an overview of the current practice of diagnostic pediatric nuclear medicine, including the common clinical applications and imaging protocol considerations.


Assuntos
Medicina Nuclear/métodos , Pediatria/métodos , Humanos , Compostos Radiofarmacêuticos
10.
Eur J Radiol ; 95: 418-427, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27142495

RESUMO

Nuclear medicine has an important role in the evaluation of various congenital and acquired pediatric chest diseases. Although the radiopharmaceuticals and nuclear medicine examinations used in children are broadly the same as in adults, there are some key differences in clinical indications and underlying disorders. This article provides the reader with an up-to-date review of practice of nuclear medicine as it relates to the pediatric chest, including its current role and future applications.


Assuntos
Medicina Nuclear/métodos , Pediatria/métodos , Cintilografia/métodos , Doenças Torácicas/diagnóstico por imagem , Adulto , Criança , Humanos , Cavidade Torácica/diagnóstico por imagem
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