SPECT/CT in pediatric patient management

  • Helen R. NadelEmail author
Review Article


Hybrid SPECT/CT imaging is becoming the standard of care in pediatric imaging. Indications are mainly for oncologic imaging including mIBG scintigraphy for neuroblastoma and I-123 post surgical imaging of children with thyroid carcinoma, bone scintigraphy for back pain, children referred from sports medicine and neurodevelopmentally delayed children presenting with pain symptoms. The studies provide improved diagnostic accuracy, and oncologic imaging that includes optimized CT as part of the SPECT/CT study may decrease the number of studies and sedation procedures an individual child may need. The studies, however, must be tailored on an individual basis as the addition of the CT study can increase exposure to the child and should only be performed after appropriate justification and with adherence to optimized low dose pediatric protocols.


SPECT/CT Child Oncology Musculoskeletal 


  1. 1.
    Fahey FH, Treves ST, Adelstein SJ. Minimizing and communicating radiation risk in pediatric nuclear medicine. J Nucl Med Off Publ So Nucl Med. 2011;52(8):1240–51. doi: 10.2967/jnumed.109.069609.Google Scholar
  2. 2.
    Gelfand MJ. Dose reduction in pediatric hybrid and planar imaging. Q J Nucl Med Mol Imaging Off Publ Ital Assoc Nucl Med Int Assoc Radiopharm Sec So. 2010;54(4):379–88.Google Scholar
  3. 3.
    Gelfand MJ, Parisi MT, Treves ST. Pediatric Nuclear Medicine Dose Reduction W. Pediatric radiopharmaceutical administered doses: 2010 North American consensus guidelines. J Nucl Med Off Publ So Nucl Med. 2011;52(2):318–22.Google Scholar
  4. 4.
    Lassmann M, Biassoni L, Monsieurs M, Franzius C, Jacobs F. The new EANM paediatric dosage card. Eur J Nucl Med Mol Imaging. 2007;34(5):796–8. doi: 10.1007/s00259-007-0370-0.PubMedCrossRefGoogle Scholar
  5. 5.
    Goske MJ, Applegate KE, Boylan J, Butler PF, Callahan MJ, Coley BD, et al. The ‘Image Gently” campaign: increasing CT radiation dose awareness through a national education and awareness program. Pediatr Radiol. 2008;38(3):265–9. doi: 10.1007/s00247-007-0743-3.PubMedCrossRefGoogle Scholar
  6. 6.
    Goske MJ, Applegate KE, Bulas D, Butler PF, Callahan MJ, Don S, et al. Image Gently 5 years later: what goals remain to be accomplished in radiation protection for children? AJR Am J Roentgenol. 2012;199(3):477–9. doi: 10.2214/AJR.12.9655.PubMedCrossRefGoogle Scholar
  7. 7.
    Jafari ME, Daus AM. Applying Image Gently SM and Image Wisely SM in nuclear medicine. Health Phys. 2013;104(2 Suppl 1):S31–6. doi: 10.1097/HP.0b013e3182764cd8.PubMedCrossRefGoogle Scholar
  8. 8.
    Kim HY, Gelfand MJ, Sharp SE. SPECT/CT imaging in children with papillary thyroid carcinoma. Pediatr Radiol. 2011;41(8):1008–12. doi: 10.1007/s00247-011-2039-x.PubMedCrossRefGoogle Scholar
  9. 9.
    Chakera AH, Hesse B, Burak Z, Ballinger JR, Britten A, Caraco C, et al. EANM-EORTC general recommendations for sentinel node diagnostics in melanoma. Eur J Nucl Med Mol Imaging. 2009;36(10):1713–42. doi: 10.1007/s00259-009-1228-4.PubMedCrossRefGoogle Scholar
  10. 10.
    Klode J, Poeppel T, Boy C, Mueller S, Schadendorf D, Korber A, et al. Advantages of preoperative hybrid SPECT/CT in detection of sentinel lymph nodes in cutaneous head and neck malignancies. J Eur Acad Dermatol Venereol. 2011;25(10):1213–21. doi: 10.1111/j.1468-3083.2010.03954.x.PubMedCrossRefGoogle Scholar
  11. 11.
    Stoffels I, Boy C, Poppel T, Kuhn J, Klotgen K, Dissemond J, et al. Association between sentinel lymph node excision with or without preoperative SPECT/CT and metastatic node detection and disease-free survival in melanoma. J Am Med Assoc. 2012;308(10):1007–14. doi: 10.1001/2012.jama.11030.CrossRefGoogle Scholar
  12. 12.
    Connolly LP, d’Hemecourt PA, Connolly SA, Drubach LA, Micheli LJ, Treves ST. Skeletal scintigraphy of young patients with low-back pain and a lumbosacral transitional vertebra. J Nucl Med Off Publ So Nucl Med. 2003;44(6):909–14.Google Scholar
  13. 13.
    Miller R, Beck NA, Sampson NR, Zhu X, Flynn JM, Drummond D. Imaging modalities for low back pain in children: a review of spondyloysis and undiagnosed mechanical back pain. J Pediatr Orthop. 2013;33(3):282–8. doi: 10.1097/BPO.0b013e318287fffb.PubMedCrossRefGoogle Scholar
  14. 14.
    Campbell RS, Grainger AJ, Hide IG, Papastefanou S, Greenough CG. Juvenile spondylolysis: a comparative analysis of CT, SPECT and MRI. Skelet Radiol. 2005;34(2):63–73. doi: 10.1007/s00256-004-0878-3.CrossRefGoogle Scholar
  15. 15.
    Gregory PL, Batt ME, Kerslake RW, Scammell BE, Webb JF. The value of combining single photon emission computerised tomography and computerised tomography in the investigation of spondylolysis. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Sect Cervical Spine Res Soc. 2004;13(6):503–9. doi: 10.1007/s00586-004-0696-2.CrossRefGoogle Scholar
  16. 16.
    Gregory PL, Batt ME, Kerslake RW, Webb JK. Single photon emission computerized tomography and reverse gantry computerized tomography findings in patients with back pain investigated for spondylolysis. Clin J Sport Med Off J Can Acad Sport Med. 2005;15(2):79–86.CrossRefGoogle Scholar
  17. 17.
    Kobayashi A, Kobayashi T, Kato K, Higuchi H, Takagishi K. Diagnosis of radiographically occult lumbar spondylolysis in young athletes by magnetic resonance imaging. Am J Sports Med. 2013;41(1):169–76. doi: 10.1177/0363546512464946.PubMedCrossRefGoogle Scholar
  18. 18.
    Yang J, Servaes S, Edwards K, Zhuang H. Prevalence of stress reaction in the pars interarticularis in pediatric patients with new-onset lower back pain. Clin Nucl Med. 2013;38(2):110–4. doi: 10.1097/RLU.0b013e318279fd23.PubMedCrossRefGoogle Scholar
  19. 19.
    Van der Wall H, Fogelman I. Scintigraphy of benign bone disease. Semin Musculoskelet Radiol. 2007;11(4):281–300. doi: 10.1055/s-2008-1060332.PubMedCrossRefGoogle Scholar
  20. 20.
    Pripatnanont P, Vittayakittipong P, Markmanee U, Thongmak S, Yipintsoi T. The use of SPECT to evaluate growth cessation of the mandible in unilateral condylar hyperplasia. Int J Oral Maxillofac Surg. 2005;34(4):364–8. doi: 10.1016/j.ijom.2004.11.002.PubMedCrossRefGoogle Scholar
  21. 21.
    Brandao SC, Gondra Lde A, Viana RA, Andrade LR, Brandt CT. Late splenosis evaluation after autoimplantation of spleen morsels in major omentum in hepatosplenic schistosomiasis patients using SPECT/CT imaging. Clin Nucl Med. 2012;37(4):372–3. doi: 10.1097/RLU.0b013e31823ea497.PubMedCrossRefGoogle Scholar
  22. 22.
    Jain A, Chauhan M, Pandit A, Kumar R, Sharma A. Promising role of single photon emission computed tomography/computed tomography in Meckel’s scan. Indian J Nucl Med Off J Soc Nucl Med India. 2012;27(3):196–8. doi: 10.4103/0972-3919.112738.Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Pediatric Radiologist and Nuclear Medicine Physician, Division of Nuclear Medicine Department of RadiologyBritish Columbia Children’s Hospital, University of British ColumbiaVancouverCanada

Personalised recommendations