I. Gordon S. Fischer K. Hahn Atlas of Bone Scintigraphy in the Pathological Paediatric Skeleton

Transcription

1 I. Gordon S. Fischer K. Hahn Atlas of Bone Scintigraphy in the Pathological Paediatric Skeleton

2 Springer Berlin Heidelberg New York Barcelona Budapest Hong Kong London Milan Paris Santa Clara Singapore Tokyo

3 Isky Gordon Sibylle Fischer Klaus Hahn ccr EANM :D=:.> '''ope''a"";p,,," of N",,"PfMect,,,,e Atlas of Bone Scintigraphy in the Pathological Paediatric Skeleton Under the Auspices of the Paediatric Committee of the European Association of Nuclear Medicine Foreword by James J. Conway With 347 Figures in 1023 Separate Illustrations Springer

4 ISKyGORDON, M.D. Great Ormond Street Hospital for Children Department of Radiology Great Ormond Street London WCIN 3JH, United Kingdom Prof. Dr. med. KLAUS HAHN SIBYLLE FISCHER Ludwig-Maximilians-Universitat Miinchen Klinik und Poliklinik fur Nuklearmedizin Ziemssenstr. 1, D Miinchen ISBN-13: : / e-isbn-13: Library of Congress Cataloging-in-Publication Data Gordon, Isky: Atlas of bone scintigraphy in the pathological paedriatic skeleton / Isky Gordon, Sibylle Fischer, Klaus Hahn; under the auspices of the Paedriatic Committee of the European Association of Nuclear Medicine. p. cm. To be used in conjunction with: Atlas of bone scintigraphy in the developing paediatric skeleton / Klaus Hahn, Siby111e Fischer, Isky Gordon Includes index. 1. Bones-Radionuclide imaging-atlases. 2. Bone diseases in children-radionuclide imaging-atlases. 3. Human skeleton-abnormalities-diagnosis Atlases. I. Fischer, Sibylle, II. Hahn, K. (Klaus) III. Hahn K. (Klaus) Atlas of bone scintigraphy in the developing paedriatic skeleton. IV Title. [DNLM: 1. Bone Diseases-in infancy & childhood-atlases. 2. Bone Diseasesradionuclide imaging-atlases.3. Fractures-radionuclide imaging-atlases. WS 17 G663a 1996] RJ482.B65H suppl ' dc DNLMlDLC for Library of Congress CIP This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9,1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. Springer-Verlag Berlin Heidelberg 1996 Softcover reprint ofthe hardcover I st edition 1996 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Typesetting: FotoSatz Pfeifer GmbH, Griifelfing SPIN: Printed on acid-free paper

5 Foreword The publication of a nuclear medicine atlas on musculoskeletal disorders indicates that the practice of paediatric nuclear medicine has matured. There are several general paediatric nuclear medicine text books available, but none which specifically addresses the use of radionuc1ides for musculoskeletal disorders. Yet, approximately one third of all paediatric nuclear medicine studies are of the musculoskeletal system. It is therefore timely that a publication specifically related to the largest organ system of the body be available to describe the rational use of paediatric bone scintigraphy and to ensure the quality of those studies. Formal training in paediatric nuclear medicine is limited for most practitioners of nuclear medicine. As a consequence, paediatric diseases and their appearances on bone scintigraphy are familiar only to the practitioner and technologist who encounter children on a daily basis. In addition, the technical requirements for quality radionuclide imaging in children are more demanding and are less well understood. The size of children varies significantly which poses technical difficulties for those with limited training and experience in the subspecialty of paediatric nuclear medicine. Since many children, if not a majority, are studied in nonpaedriatic imaging centers, an atlas of bone scintigraphy is valuable as a handy reference. An atlas allows a rapid search and a quick review of those conditions unfamiliar to the practitioner. Specific images of common and rare pathological conditions define the technique required for appropriate imaging and assist in the interpretation of unfamiliar disorders. Further an atlas concentrates the information into one easy access volume for busy practitioners to quickly localize the disease process or disorder and recognize its clinical significance. The topics presented in this atlas include all of the common and rare musculoskeletal conditions encountered in children. Special emphasis on infection, arthritis simulating infection, the characteristics of benign and malignant tumours, dysplastic conditions and unusual appearances on bone scintigraphy provide a comprehensive review of musculoskeletal disorders. This atlas is an excellent companion and complement to the publication in 1993 by the same authors (''Atlas of Bone Scintigraphy in the Developing Paediatric Skeleton", Hahn et al. Springer, Berlin Heidelberg New York). The authors are internationally renowned and acknowledged as experts in paediatric nuclear medicine. The information in this volume is based on their numerous, cumulative years of experience in both the technique and the interpretation of musculoskeletal disorders in children. Both volumes should be a standard reference in the library of every nuclear medicine department where children are studied. Its regular use will repay the user in time saved, knowledge gained, and improved quality of their practice for years to come. James J. Conway, Chicago Children's Memorial Hospital Chicago I USA v

6 Preface This atlas represents the second oftwo atlases. The Paediatric Committee of the European Association of Nuclear Medicine (EANM) believes that the quality of paediatric bone scintigraphy is very variable. Many poor quality bone scans have been seen by members of this committee as well as published in reputable journals. The first atlas was produced in an attempt to improve the overall quality of the bone scan images as well as give physicians the possibility to understand normal maturation of the growing skeleton. This second atlas focuses on pathological processes affecting the skeleton, but should be used in conjunction with the first atlas. The Paediatric Committee acknowledges the requirement of both high-quality bone-seeking Technetium 99m labelled radiopharmaceuticals and gamma camera equipment providing images of the highest quality. The nuclear medicine industry has contributed so that this atlas could be produced at a price which will hopefully allow the widest possible distribution. Acknowledgement for financial support to the following companies is gratefully expressed: Amersham Healthcare, Elscint, Kodak, Mallinckrodt Medical, Picker International, Polaroid and Siemens. I. Gordon, London S. Fischer, Munich K. Hahn, Munich VII

7 The authors would like to thank the Paediatric Committee of the European Association of Nuclear Medicine (EANM) for their continuing support of this project. The images used in this atlas have come from: Acknowledgements Great Ormond Street Hospital for Children, Department of Radiology, London, Great Britain (Dr. Isky Gordon) Klinik und Poliklinik fur Nuklearmedizin der 10hannes-Gutenberg Universitat Mainz, Mainz, Germany (Prof. Dagmar EiBner) Klinik und Poliklinik fur Nuklearmedizin der Ludwig-Maximilians Universitat Munchen, Munchen, Germany (Prof. Klaus Hahn) Red Cross Children's Memorial Hospital, Department of Nuclear Medicine, Cape Town, South Africa (Prof. Michael Mann) Hospital St. Pierre, Akademisch Zickenhuis, Department of Radiology, Brussels, Belgium (Prof. Amy Piepsz) Hospital General Vall d'hebron, Department of Nuclear Medicine, Barcelona, Spain (Dr. Isabel Roca) Hospital d'enfants Armand-Trousseau, Service de Medicine Nucleaire, Paris, France (Dr. Michel Wioland) A special thanks goes to Prof. Michael Mann and the staff of the Nuclear Medicine Department at the Red Cross Children's Memorial Hospital, Cape Town, South Africa, who have provided a large portion of the cases in the section on "Infection" as well as other cases in other chapters. Thanks are also due to Prof. Amy Piepsz, who reviewed the entire manuscript in its penultimate format. The high quality images produced by the photo laboratory in Mainz (head: Mrs. A. Keuchel) are greatly appreciated. We would also like to thank Lorenzo, Natasha and Hannah for setting up the computerized nuclear medicine museum at the Great Ormond Street Hospital for Children in London. VIII

8 Contents Chapter 1: Introdnction 1 Chapter 2: Infection 2.1 Typical Hot Lesion in Bone Lower Limbs Upper Limbs Less Common Appearances Normal Scan Going on to Abnormal Single Bone with Increased and Decreased Uptake..., Acute Osteomyelitis, Cold Lesions Only Acute Multifocal Osteomyelitis Chronic Infection, Not Tuberculosis Tuberculosis Unusual Sites, Excluding the Long Bones Skull Thorax Spine Pelvis Feet Non-skeletal Infection Growth Arrest Chapter 3: Arthritis 3.1 Septic Arthritis Typical Appearances MultifocaIArthritis Osteomyelitis as a Complication of Septic Arthritis Aseptic Arthritis Inflammatory Arthritis Irritable Hip Chapter 4: Tumours 4.1 Benign Tumours Osteoid Osteoma Osteoblastoma Benign Fibrous Cortical Defect Bone Cysts Simple Bone Cysts Fractures in a Simple Bone Cyst Aneurysmal Bone Cysts Malignant Tumours Skeletal Sarcoma Ewing's Sarcoma Osteogenic Sarcoma Chondrosarcoma Neuroectodermal Tumours Primitive Neuroectodermal Tumours Neuroblastoma Phaeochromocytoma IX

9 Contents Reticular Endothelial System Malignancy Hodgkin's Lymphoma Non-Hodgkin's Lymphoma Leukaemia Myelofibrosis Other Tumours Rhabdomyosarcoma Germ Cell Tumour Synovioma Soft Tissue Sarcoma Tumour Secondaries Effect of Treatment Metastases Langerhans' Histiocytosis Chapter 5: Trauma 5.1 Appearances at Common Sites Skull and Face Thorax and Shoulder Upper Limbs Spine Femur Fibula Feet Unusual Appearances or Locations of Fractures Stress Fracture Slipped Femoral Capital Epiphysis Spondylolisthesis Trauma Secondary to Cold Exposure Diffuse Skeletal Involvement Poly trauma Battered Child Complication of Trauma Pseudarthrosis Infection with Trauma Soft Tissue Damage Reflex Sympathetic Dystrophy - Sudeck's Atrophy Necrosis of Bone GrowthArrest Bone Response to Underlying Pathology Pathological Fracture Response to Pressure Post-operative Appearances Effect of Radiotherapy Chapter 6: Osteochondritis Dissecans - Avascular Necros~s 6.1 Legg-Perthes'Disease Other Sites of Osteochondritis Dissecans Sickle Cell Disease x

10 Contents Chapter 7: Miscellaneous 7.1 Dysplasia Fibrous Dysplasia Hemihypertrophy Osteogenesis Imperfecta Neurofibromatosis Craniodiaphyseal Dysplasia Spondyloepiphyseal Dysplasia Osteopetrosis Camurati-Engelmann Disease Mucolipoidosis Chondromata Enchondromata Exostoses Blount's Disease Gaucher's Disease Scoliosis The Sick Child Disuse Arthropathy Muscular Disorders Growth Arrest Chapter 8: Unusual Appearances of the Bone-Seeking Tracer 8.1 Kidney and Collecting System Kidney Obstruction Retention of Tracer Malignancy and / or Effect of Drugs Sickle Cell Disease Septicaemia Post-trauma Retention The Sick Child Isotope in Ureter Positional Abnormality Bladder Lung Uptake Splenic Uptake Brain Uptake Soft Tissue Calcification Isotope Artefact Injection Artefact Urine Contamination Foreign Body Artefact Free Pertechnetate Positional Abnormalities Subject Index XI