Paediatric Horner Syndrome: How much further to investigate?

We report an infant with an early-onset Horner syndrome and normal urinary catecholamine levels. Further investigations with Nuclear medicine imaging withI-MIBG (meta-iodo benzyl-guanidine) confirmed a right thoracic inlet mass consistent with a neuroblastoma, a tumor of neural crest origin. The authors emphasize the need for investigating idiopathic acquired pediatric Horner syndrome and the value of an MIBG scan as a diagnostic test for suspected neuroblastoma.

FDG PET-CT in pediatric Langerhans cell histiocytosis.

Objective: Langerhans cell histiocytosis (LCH) in pediatric patients presents with single-system or multisystem disease. Accurate staging is essential for selecting the most appropriate therapy ranging from local surgery to chemotherapy.

Methods: A retrospective review was undertaken of reported fludeoxyglucose (FDG) positron emission tomography - computed tomography (PET-CT) scans performed in children with LCH from June 2006 to February 2017.

Imaging sentinel lymph nodes.

As the technique of sentinel lymph node (SLN) biopsy has evolved over the last 22 years, it has become increasingly evident that accurate SLN imaging is vital to allow surgical removal of only the true SLN(s) and not other nodes. Identifying the lymphatic collectors draining a tumor site and following them to the draining SLNs defines which nodes need to be removed for careful histologic examination. Current technology allows the exact location of each SLN to be defined.

Voxel-based analysis of normal cerebral [18F]FDG uptake during childhood using statistical parametric mapping.

The changing pattern of relative cerebral (18)F-fluoro-2-deoxy-D-glucose (FDG) uptake that occurs during normal childhood development is not completely understood. Using SPM8 we undertook a voxel-based analysis of dedicated cerebral FDG scans in 28 children ranging in age from 11 months to 16 years to examine the effects of age on regional FDG uptake. The subjects included were children with suspected or proven extracranial malignancies without central nervous system metastases and no previous or current therapies or medical conditions likely to interfere with cerebral metabolism.

Normal cerebral FDG uptake during childhood.

Purpose: Current understanding of cerebral FDG uptake during childhood originates from a small number of studies in patients with neurological abnormalities. Our aim was to describe cerebral FDG uptake in a dataset of FDG PET scans in children more likely to represent a normal population.

Methods: We reviewed cerebral FDG PET scans in children up to 16 years of age with suspected/proven extracranial malignancies and the following exclusions: central nervous system metastases, previous malignancies, previous chemotherapy or radiotherapy, development of cerebral metastases during therapy, neurological conditions, taking antiepileptic medication or medications likely to interfere with cerebral metabolism, and general anaesthesia within 24 h.

SPECT/CT scans allow precise anatomical location of sentinel lymph nodes in breast cancer and redefine lymphatic drainage from the breast to the axilla.

Background: Historical studies of lymphatic drainage of the breast have suggested that the lymphatic drainage of the breast was to lymph nodes lying in the antero-pectoral group of nodes in the axilla just lateral to the pectoral muscles. The purpose of this study was to confirm this is not correct.

Methods: The hybrid imaging method of SPECT/CT allows the exact anatomical position of the sentinel lymph node (SLN) in the axilla to be documented during pre-operative lymphoscintigraphy (LS) in patients with breast cancer.

18F-FDG PET/CT compared to conventional imaging modalities in pediatric primary bone tumors.

Background: F-Fluoro-2-deoxy-D: -glucose (FDG) positron emission tomography (PET) is useful in adults with primary bone tumors. Limited published data exist in children.

Objective: To compare hybrid FDG positron emission tomography/computed tomography (PET/CT) with conventional imaging (CI) modalities in detecting malignant lesions, predicting response to chemotherapy and diagnosing physeal involvement in pediatric primary bone tumors.

Extrarenal malignant rhabdoid tumor in childhood application of 18F-FDG PET/CT.

Extrarenal malignant rhabdoid tumor (MRT) is a rare malignancy in childhood and has a poor prognosis. Accurate histopathologic diagnosis and staging of the malignancy has major implications for patient management. The application of F-fluoro-deoxy-glucose positron emission tomography/computed tomography (F-FDG PET/CT) in pediatric malignancy has been well described and is having a significant clinical impact in many common pediatric cancers, in particular lymphoma, brain tumors, bone and soft tissue sarcomas.

Guidelines for lymphoscintigraphy and F18 FDG PET scans in melanoma.

Melanoma has a high potential to develop metastases. Accurate staging is essential for appropriate management. Sentinel node (SN) status is a powerful prognostic factor in early stage melanoma.

Potential use of 68Ga-apo-transferrin as a PET imaging agent for detecting Staphylococcus aureus infection.

Introduction: (67)Ga citrate has been extensively used to detect infection and inflammation since 1971. However, its clinical utility is compromised due to several limitations. The present project explored whether (68)Ga-apo-transferrin ((68)Ga-TF), when prepared in vitro, is a useful agent for positron emission tomography (PET) imaging of bacterial infection.

Zolpidem for persistent vegetative state--a placebo-controlled trial in pediatrics.

Objective: The aim of this study was to determine if zolpidem is associated with improved responsiveness or regional cerebral perfusion in patients with persistent vegetative states.

Methods: Following ethics approval, children with persistent vegetative state were enrolled in a prospective, double-blind, placebo-controlled randomised trial. Patients underwent 2 treatments of 4 days, separated by 10 days.

18F-FDG PET/CT in paediatric lymphoma: comparison with conventional imaging.

Purpose: In children with Hodgkin's disease and non-Hodgkin's lymphoma, the ability of (18)F-fluoro-2-deoxy-D-glucose PET/CT and conventional imaging (CI) to detect malignant lesions and predict poor lesion response to therapy was assessed and compared.

Methods: A retrospective review of findings reported on PET/CT and CI was performed using a lesion-based analysis of 16 lymph node and 8 extra-nodal regions. Lesions were defined by histopathological findings or follow-up > 6 months.

Therapeutic nuclear medicine in pediatric malignancy.

The following review aims to provide contemporary information on therapeutic nuclear medicine procedures in paediatric malignancies. Neuroblastoma is the most common paediatric extra cranial solid cancer characterized by meta-iodobenzylguanidine (mIBG) avidity in >/=90% of patients. There exists approximately a 30-year experience with I-131-mIBG treatment.

High grade primary vesicoureteral reflux in boys: long-term results of a prospective cohort study.

Purpose: We evaluated the incidence of new permanent defects in boys with grade 4 or 5 vesicoureteral reflux, identified the risk factors for new permanent defects and reviewed the outcome of different management approaches by assessing the rates of urinary tract infection and new permanent defects.

Materials And Methods: This prospective cohort study recruited patients from July 1995 to December 2006. Study inclusion criteria were male gender and grade 4 or 5 primary vesicoureteral reflux.

Cortical hypometabolism demonstrated by PET in relapsing NMDA receptor encephalitis.

N-methyl-d-aspartate (NMDA) receptor encephalitis is a newly defined type of autoimmune encephalitis. Two girls (age 3 years, case 1, and 7 years, case 2) with relapsing NMDA receptor encephalitis each had the classic clinical features of encephalopathy, movement disorders, psychiatric symptoms, seizures, insomnia, and mild autonomic dysfunction. Both patients had persistent neuropsychiatric disability, despite immune therapies.

Utility of positron emission tomography for tumour surveillance in children with neurofibromatosis type 1.

Purpose: There is little consensus regarding optimal surveillance of optic pathway glioma (OPG) and plexiform neurofibroma (PNF) in childhood neurofibromatosis type 1 (NF1). (18)F-2-Fluoro-2-deoxy-D: -glucose (FDG) positron emission tomography and computed tomography (PET/CT) is employed in the surveillance of adult PNFs; but its utility has neither been specifically studied in children with PNFs nor in children with OPG.

Methods: Review of PET/CT studies was performed in NF1 children with OPG or PNF.

Sentinel lymph node biopsy in pediatric and adolescent cutaneous melanoma patients.

Background: The rarity of melanoma in young patients, particularly pediatric ones, has to date precluded any valid comparisons being made between young patients and adults undergoing sentinel lymph node biopsy (SLNB) for intermediate thickness localized melanoma. The present study takes advantage of the large Sydney Melanoma Unit (SMU) database to clarify this issue.

Materials And Methods: Clinical and pathologic data on pediatric and adolescent AJCC Stage I and II cutaneous melanoma patients aged <20 years undergoing SLNB at the SMU between January 1993 and February 2008 were reviewed.

Imaging of therapy-induced apoptosis using (99m)Tc-HYNIC-annexin V in thymoma tumor-bearing mice.

The primary focus of this study was to assess the potential of (99m)Tc-HYNIC-Annexin V for in vivo imaging of apoptosis after systemic chemotherapy and "more localized" radiotherapy in nude mice bearing thymoma tumors and correlating it with TUNEL staining. (99m)Tc-HYNIC-Annexin V was administered intravenously to tumor-bearing mice (n = 25) before and after therapy. Mice were then imaged at 4 hours postinjection, and the animals were subsequently sacrificed.

Hepatobiliary scintigraphy for the assessment of biliary strictures after pediatric liver transplantation.

HBS is used in the management of liver transplantation, a significant complication of which is biliary stricture. Strictures may be intraparenchymal within segments and main duct (non-anastomotic) or at the biliary-enteric anastomosis (anastomotic). Strictures are definitively diagnosed, and often managed, by PTC.

Effects of single-leg drop-landing exercise from different heights on skeletal adaptations in prepubertal girls: a randomized controlled study.

Few studies have explored osteogenic potential of prepubertal populations. We conducted a 28-week school-based exercise trial of single-leg drop-landing exercise with 42 prepubertal girls (6 to 10 years) randomly assigned to control (C), low-drop (LD) or high-drop (HD) exercise groups. The latter two groups performed single-leg drop-landings (3 sessions/week-1 and 50 landings/session-1) from 14 cm(LD) and 28 cm(HD) using the nondominant leg.

Pulmonary inflammatory myofibroblastic tumor after Hodgkin's lymphoma and application of PET imaging.

Inflammatory myofibroblastic tumor (IMT) is a rare tumor with a particular histological pattern of myofibroblasts and mixed inflammatory infiltrate. IMT has been rarely described in association with malignancy. This case report is of a 16-year-old male who had Hodgkin's disease (stage IVA) and who after chemotherapy and radiotherapy developed IMT, 16 months post completion of therapy.

Case report: consumptive hypothyroidism consequent to multiple infantile hepatic haemangiomas.

A 10-month-old infant with multiple infantile hepatic hemangiomas and developmental delay is reported. He was found to be profoundly hypothyroid. Evaluation and management issues are discussed.

Ga-67 and CT fusion imaging of an infected aortic graft.

A 17-year-old girl with a background of aortic coarctation repaired with insertion of a prosthetic graft presented with persisting fever and nonspecific back pain. Whole body Ga-67 scintigraphy was performed to evaluate occult infection. Intense uptake was noted in the region of the superior mediastinum.