Gerald A. Mandell

IMAGING TECHNIQUES IN CHILDHOOD ARTHRITIS

Technological advances in imaging have given physicians caring for children with arthritis a greater opportunity to detect abnormalities early in the course of a disease and better methods for monitoring chronic changes. Indications for using radiography, bone densitometry, nuclear medicine, ultrasound, CT scanning, and MR imaging are discussed in this article. In this era of managed care, the practicing clinician is urged more than ever to consult with the radiologist in selecting the study or sequence of studies to be used in particular case. In this way, evaluation can be limited to the most effective strategy from both the clinical and cost perspectives.

Extraosseous uptake of technetium-99m MDP in secondary deposits of neuroblastoma.

Extraosseous uptake of radiophosphate compounds i well recognized in primary neural crest tumors. In a review of 32 cases of neuroblastoma presenting over a three-year period at Childrens Hospital of Philadelphia, nine patients were noted to have secondary lesions in eleven different sites accumulating radiotracer. The extraosseous uptake in metastases included: ascites, liver, lung, anterior mediastinum, and posterior mediastinum. These cases are reported to emphasize the ability of bone imaging to detect the presence of extraosseous soft tissue metastases and primary lesions.

Accumulation of MDP in primary childhood hepatic malignancies and their metastases.

Two cases of bone radiotracer uptake by primary hepatic malignancies of childhood hepatocellular carcinoma and hepatoblastoma and their metastases are presented. These cases are illustrative of a previously unreported cause of extraosseous uptake of bone seeking radionuclide.

Bone Scintigraphic Findings in MRSA Osteomyelitis.

Methicillin-resistant Staphylococcus aureus osteomyelitis is a severe form of infection characterized by multifocal or multiple segmental osseous involvement and subperiosteal abscess formation with increased frequency of extraosseous complications including pyomyositis, septic thrombus, and septic arthritis. Bone scan showed long segment and/or multifocal involvement in 4 of 5 patients with areas of abnormal increased and decreased uptake. The clinical presentations included limp and/or pain. Joint involvement was seen in 4 cases. Bone scan abnormalities correlated well with MRI findings of severe and extensive bone disease, abscess formation, muscle, as well as joint and soft tissue involvement.

Atlas of Bone Scintigraphy in the Developing Pediatric Skeleton. The Normal Skeleton, its Variants and Pitfalls

1 Age 0- 6 Months.- 2 Age 6-12 Months.- 3 Age 1- 2 Years.- 4 Age 2- 3 Years.- 5 Age 3- 4 Years.- 6 Age 4- 5 Years.- 7 Age 5- 6 Years.- 8 Age 6- 7 Years.- 9 Age 7- 8 Years.- 10 Age 8- 9 Years.- 11 Age 9-10 Years.- 12 Age 10-11 Years.- 13 Age 11-12 Years.- 14 Age 12-13 Years.- 15 Age 13-14 Years.- 16 Age 14-15 Years.- 17 Age 15-17 Years.- 18 Age 17-22 Years.- 19 Knees.- 20 Hips.

Infarctions of the Ilia in Young Patients with Sickle Hemoglobinopathies

Infarctions of the long bones in sickle cell anemia and some of its variant hemoglobinopathies are well known. Photopenia representing areas of acute infarctions of the ilia in two young children are presented as unusual presentations of bone ischemia.

Skeletal scintigraphy in congenital syphilis.

Two infants with congenital syphilis are described. Both had bone scans, the one showing significant changes in a focal lesion, while the other was unremarkable. Radiographic changes were evident at the time of the scan in the second infant, but only became apparent later in the first case. The possible cause for this discrepancy is discussed.

Mid-line circular photopenic defects of the sternum.

A congenital mid-line circular defect in the body of the sternum occurs in approximately 2% of the population (Noonan, 1963). We report the similar scintigraphic findings of two cases, a congenital sternal mid-line circular defect and a “cold” metastatic lesion involving the body of the sternum, mimicking a congenital mid-line circular defect. An 18-year-old black girl with a two-year history of systemic lupus erythematosus presented with complaints of knee and chest pain. She had multisystem disease with pleural, cardiac, hepatic, renal and central nervous system involvement. Therapy included intermittent steroids and immunosuppressives. A bone scan with technetium 99 m methylene diphosphonate (99Tcm MDP) revealed a central well-circumscribed photopenic area in the lower portion of the sternum. (Fig. 1a) An oblique linear tomographic view showed a well denned circular defect. (Fig. 1b) A 13-year-old black boy presented with proptosis of the right eye, which was diagnosed as embryonal rhabdomyosarcoma. Vi...

Scintigraphy of Persistent Vertebral Transverse Process Epiphysis

Two cases of increased scintigraphic activity in a persistent transverse process epiphysis are presented to illustrate the need to recognize this as a normal developmental variant. Differentiation from fracture or neoplasm usually can be made by correlative radiographic imaging.

Congenital Syphylitic Hepatitis: A Case Report With Multiple Imaging Modalities (Syphilitic Hepatitis)

A case of syphilitic hepatitis is described with no evidence of mass effect on the ultrasonic and computerized tomographic study, but discrete areas of decreased uptake on liver scan suggestive of space-occupying lesion. This is the second instance in the literature of the incongruence of the liver scan and the other imaging modalities in syphilitic hepatitis.