Use of intraoperative bone scintigraphy for resection of spinal osteoid osteoma.

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.

Gastric emptying in children: what is the best acquisition method?

OBJECTIVES: The geometric mean is the recommended method for calculating gastric emptying in adults to correct for variable attenuation during the study. In children, it has been reported that a single posterior acquisition is sufficient. Our objective was to evaluate the relation between the values of gastric emptying in children obtained by posterior view only and by the geometric mean of conjugate anterior and posterior views. METHODS: The gastric residual of a standard meal was calculated in 81 children of different ages. The calculation of the gastric residual was performed with different methods, posterior only and geometric mean of anterior and posterior acquisitions. The variation between these 2 methods was evaluated in different age groups and different body weights. RESULTS: There was a high correlation (r = 0.942) between the values using posterior as compared with geometric mean for all of the patients. For children younger than 8 years and weighing <30 kg, there was no significant difference between the 2 methods for either liquid or solid meals (P = 0.89 and P = 0.11 for age; P = 0.95 and P = 0.80 for weight). For children older than 8 years and weighing >30 kg, there was no significant difference between the 2 methods for liquids (P = 0.57 for age; P = 0.69 for weight), but there was a significant difference with solids (P < 0.0001 for both age and weight). CONCLUSIONS: In children younger than 8 years and weighing <30 kg, acquisition of a single posterior image is sufficient for calculating gastric emptying at 1 hour postingestion for either liquid or solid meals. In children older than 8 years and weighing >30 kg, acquisition of both anterior and posterior images with geometric mean calculation is recommended when a solid meal is used. If a liquid meal is used in patients older than 8 years, the posterior only may be adequate.

Cheese is a reliable alternative meal for solid-phase gastric emptying study.

We evaluated the labeling stability of several alternative meals that could be used to perform solid-phase gastric emptying study. Cooked egg whites labeled with technetium-99m sulfur colloid served as a control. Packaged instant oatmeal and instant mashed potatoes were prepared by adding hot water. Cheddar cheese was melted. Peanut butter was added to bread. The different meals were mixed with technetium-99m sulfur colloid (2.2-3.7 MBq), chopped into small pieces and placed in a glass tube containing gastric juice. Four samples of each meal were analyzed after 1 and 4 h of agitation with a 3-D rotator (two samples per time point). The meal samples were washed with 2 ml of saline and filtered using a blood transfusion filter. The activity in each sample before and after filtering was assayed in a dose calibrator. The percentage of initial radioactivity remaining with the meal of admixture with gastric juice was measured and the average of the two samples was taken. The percentage of activity bound to the solid phase was 98.2+/-1.9, 95.6+/-1.1, 62.1+/-1.7, 41.8+/-0.6, and 74.5+/-3.8% at 1 h and 98.5+/-1.0, 95.8+/-2.6, 77.2+/-6.8, 55.5+/-3.4 and 40.2+/-22.1 at 4 h for egg whites, cheese, oatmeal, mashed potatoes and peanut butter respectively. For egg whites and cheese, there was no significant difference between the values at 1 and 4 h (P>0.8). Cheddar cheese provides an alternative meal for assessing solid gastric emptying in children comparable to egg whites. Oatmeal and mashed potatoes had low and variable labeling stability and are not recommended. In view of the significant proportion of pediatric patients who refuse to eat scrambled eggs or have allergy to eggs, the availability of other meal choices is essential. The versatility of cheddar cheese, which can be added to macaroni or as a topping on pizza, makes it a useful alternative to labeled eggs.