Metastatic bone lesions in children, current assessment of radionuclide skeletal survey

Bone scintigraphy is more sensitive than radiographic skeletal survey in early diagnosis of bone metastases from pediatric solid tumors. Organic phosphorus compounds of labelled 99 m technetium are currently the far most used, and the pattern of imaging is compared to normal skeletal distribution of the radionuclide in childhood. From the most important series of the recent literature and their own experience, the authors ask the value of the procedure and describe overall results: a reliable diagnosis of bone metastases is done in 25 to 50% of the metastatic patients several weeks or months earlier than by radiographs: false positive are rarely misleading if usual pitfalls have been discarded: false negative are encountered in approximately 10% of the cases: post-therapeutic changes may be confusing. Some more details are given for neuroblastoma in which ''cold'' metastases and symetrical long bone's metaphysis involvement may display a misleading aspect. The selective uptake of the tracer by the primary is also underlined in this tumor. Finally indications of radionuclide skeletal survey, -at diagnosis and during and after the treatment-, are proposed for patients at risk amongst children with malignant solid tumors