Pediatric Nuclear Medicine PDF
Preview Pediatric Nuclear Medicine
Pediatric Nuclear Medicine Second Edition S.T. Treves Editor Pediatric N uclear Medicine Second Edition With a Foreword by Henry N. Wagner, Jr. With 509 Figures, 4 in Color Springer Science+Business Media, LLC S.T. Treves,M.D. Chief, Division ofNuciear Medicine Children's Hospital; Professor ofRadiology Harvard Medical School Boston, MA02115 USA Library ofCongress Cataloging-in-Publication Data Treves, S. T. Pediatric nucIear medicine / S. T. Treves. - 2nd ed. p. cm. IncIudes bibliographical references and index. 1. Pediatric nucIear medicine. I. Title. [DNLM: 1. NucIear Medicine. 2. Pediatrics. 3. RadionucIide Imaging - infancy & childhood. WN 446T812p 1994] RJ51.R33T74 1994 618.92'007575 -dc20 DNLMlDLC for Library of Congress 94-9627 Printed on acid-free paper. ©1995, 1985 Springer Science+Business Media New York Originally published by Springer-Verlag New York Inc in 1995. Softcover reprint of the hardcover 2nd edition 1995 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher Springer Science+Business Media, LLC, except for brief excerpts in connection with reviews or scholarly analysis. U se in con- nection with any form of information and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibil ity for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Production managed by Terry Komak; manufacturing supervised by J acqui Ashri. Typeset by ATLIS Graphics & Design, Inc., Mechanicsburg, PA. 9 8 7 6 543 2 1 ISBN 978-1-4757-4207-7 ISBN 978-1-4757-4205-3 (eBook) DOI 10.1007/978-1-4757-4205-3 To Nancy, Erik, Alex, and Blake, and to my parents Catherine and Elias Foreword This second edition of Pediatric Nuclear Medicine incorporates the major advances that have been made in nuclear medicine over the ten years since the publication of the first edition. There are nine new chapters, and twice as many contributors, most of whom devote their practice to the care of children. The book describes in clear, weIl-written chapters, when nuclear medicine proce dures are medically necessary and appropriate, and how they can help answer the four basic questions that make up the practice of medicine: What is wrong? How did it happen? What is going to happen? and What can we do about it? The practice of medicine is being reshaped in major ways. The benefits of nuclear medicine procedures have not been exaggerated in the past. The prob lem has been that neither the public nor physicians outside of the field of nuclear medicine are sufficiently aware of the enormous value of this approach to patient care. Nuclear medicine procedures are not just new tests for old diseases, but a whole new way of looking at disease. Nuclear medicine is a way oflooking at the patient's problems as problems in regional physiology and biochemistry, rather thanjust from the viewpoint of anatomy and histopathology. This book will help ensure that high-quality nuclear medicine care is always there for children as weIl as adults. Nuclear medicine has the ability to change concepts of disease and the practice of medicine by applying advances in genet ics, molecular biology, and pharmacology to the care of patients and prevention of disease. Nuclear medicine can serve as the link in the chain that extends from anatomy through physiology to biochemistry. Disease manifestations can be related to abnormal regional chemistry. In many cases, chemical manifestations may be the only objective evidence of disease, for example, in mood disorders such as depression, or in developmental disorders such as Down's syndrome. No other field is able to relate brain chemistry to thinking, mood, and behavior. Nuclear medicine studies are of three general types: regional blood flow and tissue perfusion, energy supply, and intercellular communication as informa tion travels from the extemal world to nerves, muscles, and glands. New tracers are continually being developed, validated, and used in biomedical research prior to being transferred to clinical practice. The tracer molecules must be labeled with a gamma or positron emitting radionuclide to permit the use of radionuclide imaging devices for non-invasion measurements in the patient. Second, the tracer must be able to reach the binding site. In the case of the brain, it must cross the blood-brain barrier. vii viii Foreword Studies of the brain with single photon and positron emitting radiotracers may be as important alandmark in human neurobiology as the discovery that neuronal activity was associated with measurable electrical activity within the human brain, a finding that led to the diagnostic modality, electroencephalogra phy. Radioactive tracer positron emission tomography makes possible measure ment of regional chemistry within the living human body, and can provide a new approach to planning and monitoring treatment. The goal of radionuclide imaging is not the production of images per se, but quantification of the amount of tracer within the region of interest at various times after injection of the tracer. From this one can examine specific regional biochemical processes, such as the rate of a chemieal reaction taking place in various regions of the brain. Perhaps the most important contribution of radiotracer imaging technologies, such as PET and SPECT, is to decrease the heterogeneity of patients with dis eases that are collections of abnormalities, such as mental disorders. Identification of patient subtypes would facilitate all research, and be of special value in genetie studies. Many diseases have a genetie component. Identification of genetic abnormalities in persons susceptible to specific dis eases is an important step in elucidation of molecular defects responsible for the disease, and could ultimately lead to more effective treatment. Reflecting the concems of the times, the authors emphasize how nuclear medicine procedures not only help siek children, but also how they can reduce the cost of their care, even while maintaining a high standard of excellence in the performance and interpretation of the studies. There is emphasis on prevention by early diagnosis and physiologieal characterization of disease. For example, in congenital abnormalities in the newbom, functional assessment of the effects of structurallesions can often prevent unnecessary surgery, and, when surgery is indieated, reduce operative complications by providing useful apriori informa tion to the surgeon. In the context of the major changes occurring in medieine throughout the world, this book will help inform primary care physieians, including pediatri cians and farnily physicians, of the important contributions of radioactive tracer procedures in the prevention, diagnosis, and treatment of disease in children. The book will be an important contribution to the education needed to help ensure that there are qualified physicians and technologists to provide the val ued procedures, incorporating them into the total care of the patient. This book will not only help medical students, residents, and nuclear medi cine physicians, but also inform referring doctors, health planners, and the pub lic of what radioactive tracer studies can provide in patient care. It describes the type of nuclear medicine that all physicians and other health care personnel would like to provide in the care of sick children. Henry N. Wagner, Ir., M.D. ProfessorofMedicine, Radiology, and Environmental Sciences; Director, Division ofNuclear Medicine and Radiation Health Sciences lohns Hopkins Medieal Institutes Baltimore, MD USA Preface Many changes in pediatric nuc1ear medicine have taken place since the publica tion of the first edition of this book nearly ten years ago. New diagnostic proce dures have been introduced, while other methods, such as conventional brain and liver-spleen scintigraphy, have been superceded by computed tomography (CT), magnetic resonance imaging (MRI), or ultrasonography. There have been dramatic improvements in radiopharmaceuticals, instrumentation, and com puter systems. Single photon emission computed tomography (SPECT) has become an essential tool in pediatric nuc1ear medicine practice. Although this book reflects in great part the experience in the pediatric appli cations of nuc1ear medicine at the Children 's Hospital in Boston during the past twenty years, several distinguished colleagues have generously contributed to this second edition. This book is divided into several chapters according to organs and systems. The first chapter addresses many general aspects of pediatric nuc1ear medicine. Each subsequent chapter contains an introduction in which principles, indica tions, and general considerations are discussed. Next, a section on methods is presented that inc1udes radiopharmaceuticals, adrninistered doses, exarnination technique, and analysis. Clinical applications of pediatric nuc1ear medicine are discussed in each chapter and several examples of pediatric disorders are illus trated. There are chapters addressing radiation absorbed doses, radiation risks, SPECT, and magnification scintigraphy. This book concentrates specifically on pediatric aspects of nuc1ear medicine, and is therefore not intended to provide a multimodality review of pediatric imaging. The field of diagnostic imaging is changing rapidly and today's "well established dogmas" on the proper sequencing of imaging modalities tend to become obsolete with experience, and as more information becomes available and digested. Pediatric nuc1ear medicine has become a larger and more complex field than it was many years ago. This book does not, therefore, intend to present an exhaustive review of the world literature on the subject. Nevertheless, I apolo gize in advance for any omissions and errors. Pediatric nuc1ear medicine has a bright future indeed, and in the next few years, many further advances in this field should be anticipated. My distin guished collaborators and I hope that in reading this book, physicians, technolo gists, fellows, residents, intems, students, and nurses will find useful information when taking care of children. S.T. Treves ix Acknow ledgments Meticulous technical support was provided by the following Nuclear Medicine Technologists: Royal T. Davis, Jim Ulanski, Diane Itrato, Terry Wilson, Jennifer Winfield, Janice Costello, Tory Tucker, and Daniel Shea. Their dedica tion, care, patience, and compassion in dealing with pediatric patients cannot be acknowledged enough. Helena Rodrigues helped in several aspects of manuscript preparation. Judy Mitiguy, Wendy Callahan, and Len P. Connolly, M.D. provided valuable editor ial assistance. Karl Mitchell provided exquisite expertise and assistance in clinical data base research, computer support, and imaging including electronic image registra tion and fusion. Isam Haboush helped with image registration and fusion. Miriam GeIler and Allison Clapp, librarians at the Children's Hospital in Boston, provided invaluable support in expert computerized literature research. The Production Department at Springer-Verlag, New York worked with tremendous dedication, care, and patience to ensure that the text was produced with the highest standards. I would like to thank Bill Day, Executive Editor at Springer-Verlag, New York, for his support during the inception and develop ment of this second edition. The color illustrations in Chapter 1 were made possible thanks to the support ofBob Lythle and Corrine Schmidt, from Siemens Gammasonics Inc., Hoffman Estates, 11. Jay McSweeney and Jim Cooper from Apple Computer Inc. provided com puter hardware used in parts of the preparation of this book. I would like to acknowledge the kind and constant encouragement from sev eral of my friends and colleagues. Special thanks are expressed to Jim Adelstein, M.D. for his constant support, encouragement, and kindness. FinaIly, I would like to thank my wife Nancy and my family for their support, patience, and understanding. Contents Foreword ............................................................. vii Henry N. Wagner, Ir. Preface ................................................................ ix Acknowledgments ...................................................... x Contributors .......................................................... xv 1 Introduction ....................................................... 1 S.T. Treves 2 Pediatric Sedation for N uc1ear Medicine Procedures .................. 12 Patricia E. Burrows 3 Radiation Risk .................................................... 17 S.lamesAdelstein 4 Magnification in Pediatric Nuc1ear Medicine ........................ 24 Royal T. Davis, Robert E. Zimmerman, and S. T. Treves 5 Single Photon Emission Computed Tomography ..................... 33 Mark W. Groch, William D. Erwin, and lohnA. Bieszk 6 Brain ............................................................. 88 L.A. 0 'Tuama, B. Bjornson, H. Chugani, and S. T. Treves 7 Cerebrospinal Fluid .............................................. 109 S.T. Treves, L.A. O'Tuama, andA. Kuruc 8 Dacryoscintigraphy .............................................. 121 Sydney Heyman and lames A. Katowitz 9 Thyroid ......................................................... 135 H.J. Paltiel, R. Larsen, and S. T. Treves xi
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