Brain tumors in paediatrics
Edition 12/12 of the Webinar Series on Paediatric Nuclear Medicine
Created in cooperation with IAEA

Brief summary of contents

After a short introduction, the diagnostic impact of PET and SPECT in pediatric brain tumor diagnosis is reviewed in comparison with conventional MRI. This concerns the improved delineation of brain tumors for therapy planning and biopsy guidance, information on grading and prognosis, differentiation of recurrent tumor from unspecific post therapeutic changes and therapy monitoring. For each aspect clinical cases are demonstrated. Finally, the webinar will end with a summary of the main teaching points.



Content: Presentation and MCQ test (10 questions)

Length: 00:46:15 min



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Paediatric Neuroblastoma Imaging
Edition 11/12 of the Webinar Series on Paediatric Nuclear Medicine
Created in cooperation with IAEA

Brief summary of contents

Neuroblastoma is an embryonic tumor of the peripheral sympathetic nervous system, and is metastatic or otherwise high risk for relapse in nearly 50% of cases, with a long-term survival of <40%. Therefore, exact staging with radiological and nuclear medicine imaging methods is crucial for finding the adequate therapeutic choice. The tumor cells express the norepinephrine transporter, which makes metaiodobenzylguanidine (MIBG), an analogue of norepinephrine, an ideal tumor specific agent for imaging. On the other hand, MIBG imaging has several disadvantages as limited spatial resolution, limited sensitivity in small lesions, need for two or even more acquisition sessions, and a delay between the start of the examination and result. Most of these limitations can be overcome with positron emission tomography (PET) using different radiotracers. Furthermore, for operative or biopsy planning, a combination with morphological imaging methods is indispensable. This webinar will discuss the therapeutic strategy for primary and follow-up diagnosis in neuroblastoma using MIBG scintigraphy and different new PET tracers as well as multimodality imaging.

Content: Presentation and MCQ test (10 questions)
Length: 00:41:58 min



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Paediatric pitfalls in PET/CT
Edition 10/12 of the Webinar Series on Paediatric Nuclear Medicine
Created in cooperation with IAEA

Brief summary of contents

The Webinar starts with some general definitions of the term “pitfall” and then focuses on the specific meaning of the term in Nuclear Medicine imaging, comprising PET/CT. The overall structure of the presentation is divided into some separate sessions introducing the reader to the argument. Three general rules for the recognition of paediatric pitfalls are presented in the beginning and their explanation into pictorial slides represents the main structure of the webinar. The definition of the term “artefact” and the presentation of some of its most frequent presentations is also shown in a separate session. To keep the audience interactive, three examples with multiple choice questions are presented in the last part of the webinar.

Content: Presentation and MCQ test (10 questions)
Length: 00:34:45 min



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PET/CT in paediatric lymphoma
Edition 9/12 of the Webinar Series on Paediatric Nuclear Medicine
Created in cooperation with IAEA

Brief summary of contents
  • Short overview over types of paediatric lymphoma
  • The current Lugano criteria
  • Role of PET in staging
  • Role of PET in response assessment
  • Methodological information for patient preparation
  • Interpretation rules
  • Cases
Content: Presentation and MCQ test (10 questions)

Length: 00:18:32 min



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Multimodality Imaging in Paediatric Oncology
Edition 8/12 of the Webinar Series on Paediatric Nuclear Medicine
Created in cooperation with IAEA

Brief summary of contents
Different imaging strategies with bone scintigraphy, MIBG scintigraphy, PET and/or MRI at diagnosis and in follow-up will be discussed with emphasis on the strengths and weaknesses of each modality. In this context, specific indications for MRI versus CT will be pointed out. Keeping the radiation burden as low as possible is particularly interesting in children. Therefore, it will be discussed which imaging modality may not be necessary in the diagnostic work-up. Finally, necessity for combined PET/MRI with or without image registration will be discussed and the relative applications demonstrated.

Content: Presentation and MCQ test (10 questions)

Length: 00:34:39 min



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Paediatric NM evaluation of antenatal hydronephrosis (Spanish)
Edition 7/12 of the Webinar Series on Paediatric Nuclear Medicine
Created in cooperation with IAEA

Brief summary of contents

Antenatal hydronephrosis, consisting in the dilatation of urinary collecting system, unilaterally or bilaterally, is the most common congenital malformation, being found in 1 to 5% of all pregnancies. It is estimated that in 36% of these situations pathology is found after birth and can be associated with loss of renal function, if left untreated. Therefore, there is need to have a comprehensive post-natal management [1-6]. 

After birth, a renal and bladder ultrasound (US) is usually performed between the 5th and the 30th day of life. If it confirms a moderate to severe hydronephrosis, or if other US signs of parenchymal suffering are present, a diuretic dynamic renal scintigraphy is performed, in order to exclude the most probable diagnosis, which is the pyeloureteral junction obstruction or, less frequently, the ureterovesical junction obstruction, if there is also ureteral dilatation. Through this exam relative renal function and drainage are evaluated, and used for the decision to operate or not [7]. So, it is important to use a standardized protocol in order to have reproducible and comparable results. The most relevant aspects of the protocol are revised on the presentation, namely: preparation for the exam, acquisition and processing details, interpretation of the images and quantitative data, and main pitfalls [8-22].

The second nuclear medicine procedure that can be helpful for the diagnostic work-up of antenatal hydronephrosis is the radionuclide direct cystography. The risk of having vesicoureteral reflux is present at all degrees of pelvic dilatation, and most of them resolve spontaneously. Thus, the indications for this exam are more limited and controversial. They will be shortly revised, as well as more relevant technical details and comparison to the radiological equivalent, the voiding cystourethrogram [23,24].

Finally, 6 clinical cases are presented, to document the most frequent situations found in clinical practice, as well as some future prospects are pointed out [25,26]. 

Content: Presentation and MCQ test (10 questions)
Length: 00:38:08 min



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Nuclear Medicine Evaluation of Gastroesophageal Reflux and Pulmonary Aspiration in Children (English)
Edition 6/12 of the Webinar Series on Paediatric Nuclear Medicine
Created in cooperation with IAEA

Brief summary of contents

The pathogenesis, clinical presentations and complications of gastroesophageal reflux, gastroesophageal reflux disease and pulmonary aspiration in children are presented. Diagnostic imaging methods are discussed. The focus of the webinar is on two scintigraphic studies, gastroesophageal reflux scintigraphy (the “milk scan”) and the radionuclide salivagram. These studies have a central role in the evaluation of these conditions. The preparations for these studies, tracer administration techniques and imaging protocols are presented. Typical findings interpretation criteria and pitfalls are discussed. Clinical cases with typical scintigraphic findings of gastroesophageal reflux, aspiration of gastric contents and aspiration of salvia are shown. The clinical significance of these findings is emphasized. The strengths and limitations of gastroesophageal reflux scintigraphy and the radionuclide salivagram in comparison to alternative radiological tests are discussed.

Content: Presentation and MCQ test (10 questions)
Length: 00:36:48 min

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Paediatric non Oncologic Bone Scintigraphy (English)
Edition 5/12 of the Webinar Series on Paediatric Nuclear Medicine
Created in cooperation with IAEA

Brief summary of contents

The main paediatric indications of bone scintigraphy are presented, with a focus on the most frequent, namely infection, fracture and hip disorders. Clinical cases are used to illustrate routine practice.

Content: Presentation and MCQ test (10 questions)
Length: 00:34:00 min

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Cortical (Static) Renal Scintigraphy and Radionuclide Cystographies (Spanish)
Edition 4/12 of the Webinar Series on Paediatric Nuclear Medicine
Created in cooperation with IAEA

Brief summary of contents

The webinar is organized through 5 steps: 

  • Description of basic technique of the exams and how to get rid of some practical problems
  • Clinical application and diagnostic accuracy
  • Actual position of radionuclide studies into the published clinical guidelines and the areas of controversy about their use
  • Clinical cases
  • Take home messages

Content: Presentation and MCQ test (10 questions)
Length: 00:39:19 min

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Paediatric Lung Scintigraphy (Spanish)
Edition 3/12 of the Webinar Series on Paediatric Nuclear Medicine
Created in cooperation with IAEA

Brief summary of contents

Lung perfusion scintigraphy in congenital heart defects offers a unique possibility of evaluating pulmonary blood flow symmetry in a simple non-invasive way, but It requires a careful planning, taking in account many pathophysiologic and anatomical details. The course will review indications and practical issues for lung perfusion scintigraphy in children with congenital heart defects (patient preparation, radiopharmaceutical dose, number of particles scaling, selection of the injection site, etc). The user will be confronted with typical findings in some clinical cases, representing some of the common indications found in the clinical routine. Multiple-choice questions will help to focus on some critical issues.

Content: Presentation and MCQ test (10 questions)
Length: 00:19:48 min

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Paediatric Thyroid Scintigraphy in Children (Spanish)
Edition 2/12 of the Webinar Series on Paediatric Nuclear Medicine

Created in cooperation with IAEA

Brief summary of contents

The main paediatric indications of thyroid scintigraphy are presented, with a focus on congenital hypothyroidism, including perchlorate discharge test.
The methodology and basis of interpretation are discussed.
Clinical cases illustrate routine practice, problems or possible pitfalls. 

Content: Presentation and MCQ test (8 questions)
Length: 00:17:33 min



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Myocardial Perfusion Scintigraphy in Paediatric Cardiology (English)
Edition 1/12 of the Webinar Series on Paediatric Nuclear Medicine

Created in cooperation with IAEA

Brief summary of contents

Myocardial molecular imaging in children presents many technical similarities with the usage in adults and a crucial difference, due to the different disease spectrum, where atherosclerotic coronaropathy is absent and cardiac malformations management requires precise anatomical definition.
The course will review indications and practical issues for stress/rest imaging (patient preparation, pharmacological stress administration, radiopharmaceutical dose and injection, etc). The user will be confronted with typical findings in some clinical cases, representing some of the common indications found in the clinical routine.
Multiple choice questions will help to focus on some critical issues.

Content: Presentation and MCQ test (10 questions)
Length: 00:24:01 min



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