SPECT and PET in paediatrics

SPECT and PET are useful tools in paediatrics as well as in adults, improving the sensitivity and the diagnostic accuracy. Both techniques have a special interest for the the correlative image, improving the clinical usefulness of both metabolic (SPECT and PET) and anatomic images (MRI, CT, US). SPECT tomographic images are useful in most of the paediatric fields, but specially in oncology, neurology, orthopaedia and cardiology. In paediatric oncology, SPECT images obtained after the injection of metabolic tracers as MIBG, sodium iodine or octreotide allows us to detect residual tumour (neuroblastoma, thyroid tumour or carcinoid). SPECT increases the sensitivity to detect small lesions, lesions closed to bigger tumours, deep lesions or lung metastasis of osteosarcoma. Radioguided surgery is an emerging field in Nuclear Medicine. In Paediatrics, SPECT and SPECT-CT (or SPECT-MR) are useful to assist the surgeon to localize residual tumoral mass (neuroblastoma, thyroid cancer lymph nodes) as well as radioguides biopsy (lymphoma). The usefulness of brain SPECT in paediatric neurology is well known. Brain SPECT images are routinely used to localize epileptic foci, but also for a better understanding of most of the neuropsychologic paediatric diseases (brain death, trauma, vascular diseases, encephalitis, brain maturation, language disorders, obsessive-compulsive disorder, attention deficit disorderhyperactivity, etc.). In benign bone diseases, like Perthes disease, osteoid osteoma, bone infection or bone fractures, SPECT images improve the sensitivity and accuracy of bone scan and white blood cell scintigraphy. The tomographic frames, alone or fused with CT or MRI, provide important clinical information referred to the lesion extension or localization (v.g. radioguided surgery for an optimal removal of the nidus in osteoid osteoma). In nephrourology, the benefit of SPECT images compared to DMSA cortical renal scintigraphy is not well accepted by most of the authors, specially because it represents an increase of the injected dose. Paediatric cardiology not only needs always the use of tomographic techniques but also an improvement in the acquisition parameters: zoom, immobilization, reconstruction parameters. The main applications during childhood are cardiac and pulmonary shunts, abnormal coronary artery and lung transplantation