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PYP Scan (Technetium Pyrophosphate Scintigraphy)

Nuclear medicine and multimodality imaging of pediatric neuroblastoma. Review First Online: 14 November This is a preview of subscription content, log in to check access. Is the expression of somatostatin receptors a prognostic factor? Am J Roentgenol — Google Scholar. A scintigraphic portrayal using I-metaiodobenzylguanidine. Claudiani F, Stimamiglio P, Bertolazzi L et al Radioiodinated meta-iodobenzylguanidine in the diagnosis of childhood neuroblastoma. Gelfand MJ Meta-iodobenzylguanidine in children.

Hadj-Djilani NL, Lebtahi NE, Delaloye AB et al Diagnosis and follow-up of neuroblastoma by means of iodine metaiodobenzylguanidine scintigraphy and bone scan, and the influence of histology. Pfluger T, Schmied C, Porn U et al Integrated imaging using MRI and I metaiodobenzylguanidine scintigraphy to improve sensitivity and specificity in the diagnosis of pediatric neuroblastoma. McGarvey CK, Applegate K, Lee ND et al False-positive metaiodobenzylguanidine scan for neuroblastoma in a child with opsoclonus-myoclonus syndrome treated with adrenocorticotropic hormone acth.

Moralidis E, Arsos G, Papakonstantinou E et al I-Metaiodobenzylguanidine accumulation in a urinoma and cortex of an obstructed kidney after surgical resection of an abdominal neuroblastoma. Matthay KK, Edeline V, Lumbroso J et al Correlation of early metastatic response by I-metaiodobenzylguanidine scintigraphy with overall response and event-free survival in stage IV neuroblastoma.

Br J Cancer — Google Scholar. Kushner BH, Yeung HW, Larson SM et al Extending positron emission tomography scan utility to high-risk neuroblastoma: fluorine fluorodeoxyglucose positron emission tomography as sole imaging modality in follow-up of patients. Shulkin BL, Hutchinson RJ, Castle VP et al Neuroblastoma: positron emission tomography with 2-[fluorine]-fluorodeoxy-D-glucose compared with metaiodobenzylguanidine scintigraphy.

Radiology — PubMed Google Scholar. Schwaiger M, Hutchins GD, Kalff V et al Evidence for regional catecholamine uptake and storage sites in the transplanted human heart by positron emission tomography. Schwaiger M, Kalff V, Rosenspire K et al Noninvasive evaluation of sympathetic nervous system in human heart by positron emission tomography. Complete bony union offers the best long term prognosis. Some patients attain a fibrous union and are consequently able to return to prior activity, with favorable short-term prognoses.

Treatment often includes rest from aggravating activities, non steroidal anti-inflammatory medication, bracing and physical therapy emphasizing hamstring stretching and core strengthening. The length of activity restriction, use of bracing and type of rehabilitation programs varies, reflecting a lack of consensus among practitioners. In recalcitrant cases, electrical stimulation may be added [ 9 , 27 , 28 ].

Pediatric Skeletal Scintigraphy

Prompt treatment of patients with early pars stress has been shown to result in more predictable symptom relief and less likelihood of progression to spondylolisthesis [ 29 — 31 ]. Studies have consistently demonstrated that SPECT is more sensitive than planar bone scintigraphy to identify skeletal lesions [ 31 — 33 ]. Collier et al. In a long-term follow-up study, Bellah et al.

Even-Sapir et al. Strobel et al. We conducted an internal review of all patients with low back pain or suspected spondylolysis referred to the Division of Nuclear Medicine at Children's Hospital, Boston for skeletal scintigraphy between October and September In general, SPECT increases contrast and improves anatomic localization in comparison to planar scintigraphy [ 34 ].

In SPECT, images are acquired in multiple projections with the gamma scintillation camera traversing an axial orbit about the patient. Filtered back projection FBP or an iterative reconstruction algorithm such as OSEM ordered subsets expectation maximization is then used to create a cross-sectional image.


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The cross-sectional image is a two-dimensional representation of a slice through the patient that would project onto a single dimension on a planar bone scan. In addition, SPECT images may be displayed as a 3D representation using a volume rendered display to provide better spatial orientation. Maeseneer et al.

Degenerative disk disease might show increased tracer uptake centered about the disk space. Pars interarticularis stress might show tracer uptake in the expected location of the pars interarticularis and metastatic disease is more likely to involve the vertebral body with extension to the pedicle [ 35 , 36 ].

The economic burden of back pain is significant and growing. Epidemiological studies suggest a correlation between adult and adolescent complaints. Pars interarticularis injury, a spectrum of disease ranging from bone stress to spondylolysis and spondylolisthesis, is the most common identifiable cause of ongoing low back pain in adolescent athletes. In the current era of multi-modality imaging, radiographs, skeletal scintigraphy, CT and MRI all play an important role in imaging patients with back pain.

Planar bone scintigraphy has a long history in the diagnosis of patients with suspected injury of the pars interarticularis because it is more sensitive than radiographs for localizing the site of bone stress and because CT of the spine is associated with significant ionizing radiation. The addition of SPECT to planar skeletal scintigraphy increases sensitivity and improves disease localization without exposing the patient to additional radiation. As such, incorporation of SPECT into the standard planar bone scintigraphy routine should lead to a more accurate initial diagnosis.

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It is our hypothesis that by improving our ability to promptly diagnose patients with suspected injury of the pars interarticularis, the patients will be better served and the long-term cost of management can be lowered. The Spine Journal. Kim H, Green D: Adolescent back pain. Current Opinion in Pediatrics. Bernstein R, Cozen H: Evaluation of back pain in children and adolescents. American Family Physician.

Standaert C, Herring S: Expert opinion and controversies in sports andmusculoskeletal medicine: The diagnosis and treatment of spondylolysis in adolescent athletes.

Archives of Physical Medicine and Rehabilitation. Gregory P, Batt M, Kerslake R, Webb J: Single photon emission computerized tomography and reverse gantry computerized tomography findings in patients with back pain investigated for spondylolysis. Clinical Journal of Sport Medicine. Significant differences from adults in causes and patterns.

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Archives of Pediatrics and Adolescent Medicine. Clinics in Sports Medicine. Micheli LJ: Low back pain in the adolescent: differential diagnosis. The American Journal of Sports Medicine. Micheli LJ: Back injuries in dancers.

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Clinical Journal of Sports Medicine. A cause of adolescent low back pain. Journal of Adolescent Health Care. Sports Medicine and Arthroscopy Review. British Journal of Sports Medicine. Pennell R, Maurer A, Bonakdarpour A: Stress injuries of the pars interarticularis: radiologic classification and indications for scintigraphy. American Journal of Roentgenology. Standaert C, Herring S: Spondylolysis: a critical review. Muskuloskeletal Radiology. Clinical Radiology. Journal of Bone and Joint Surgery.

The New England Journal of Medicine. Skeletal Radiology. Gregory P, Batt M, Kerslake R, Scammell B, Webb J: The value of combining single photon emission computerized tomography and computerized tomography in the investigation of spondylolysis.

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European Spine Journal. Fellander-Tsai L, Micheli LJ: Treatment of spondylolysis with extreme electrical stimulation and bracing in adolescent athletes: a report of 2 cases. A case report. Journal of Athletic Training. Takemitsu M, Rassi G, Woratanarat P, Shah S: Low back pain in pediatric athletes with unilateral tracer uptake at the pars interarticularis on single photon emission computed tomography.


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  8. Journal of Pediatric Orthopaedics. The Journal of Nuclear Medicine. Seminars in Nuclear Medicine. European Journal of Nuclear Medicine. Download references. Correspondence to S Ted Treves. Reprints and Permissions. Search all BMC articles Search. Abstract The medical cost associated with back pain in the United States is considerable and growing.

    The Diagnosis and Treatment of Spondylolysis Athletes comprise the majority of patients presenting with spondylolysis [ 10 — 12 ]. Figure 1. Full size image. Figure 2.