Paediatric Nuclear Cardiology
In recent decades a number of radionuclide cardiac procedures have greatly contributed to the pathophysiologic understanding and clinical diagnosis of congenital and acquired paediatric heart disease.
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Paediatric Nuclear Cardiology
34
Pietro Zucchetta
34.1
Contents
34.1 34.2 34.2.1 34.2.2 34.2.3
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . Myocardial Perfusion Imaging . . . . . . . . . . . Clinical Applications . . . . . . . . . . . . . . . . . . . Myocardial PET Scan . . . . . . . . . . . . . . . . . . Lung Perfusion Scan . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . .
Introduction
401 402 403 403 404 405
In recent decades a number of radionuclide cardiac procedures have greatly contributed to the pathophysiologic understanding and clinical diagnosis of congenital and acquired paediatric heart disease. The dramatic improvement in high-resolution morphological imaging (echocardiography, cardiac catheterization, MRI) has reduced the role of scintigraphic studies in this field, particularly in shunt evaluation. Nonetheless, nuclear medicine continues to make major contributions to the management of these patients, evaluating pulmonary blood flow distribution, myocardial perfusion or ventricular function. Nuclear medicine studies applied to paediatric cardiology require a specialized approach, even if radiopharmaceuticals and acquisition techniques largely overlap those in adult practice. A completely different disease spectrum (congenital heart disease vs. atherosclerotic coronary artery disease) and the particular needs of patients throughout childhood require significant modifications of adult protocols and a different mind set to obtain high quality, informative studies [1]. Modifications encompass the need to adequately inform and reassure the child and parents, the adapting of acquisition protocols to single patient characteristics (height, weight, cooperation level), the use of sedation, and modified hardware (from smaller ECG electrodes to special acquisition cradles). Radiation protection is a highly sensitive topic in paediatric imaging, considering the higher radiation sensitivity of children, and every measure must be taken to minimize radiation exposure. Nevertheless radiation protection cannot be reduced to extreme dose reduction [2], which often leads to sub-optimal studies, requiring repeated radiopharmaceuticals administrations or the use of invasive diagnostic techniques. Therefore much effort has been directed towards identification of the most appropriate radiopharmaceutical schedule in children and methods based on weight or body surface area are the most accepted choices (Table 34.1) [3]. Study tailoring to the single patient represents the best way to optimize radiation exposure and should
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Pietro Zucchetta
Table 34.1 Paediatric dose schedule following the suggestion of the Paediatric Task Group of the European Association of Nuclear Medicine [5]
Body weight
Body weight
kg
Fraction of administered activity %
Body weight
kg
Fraction of administered activity %
kg
Fraction of administered activity %
3
10
22
50
42
78
4
14
24
53
44
80
6
19
26
56
46
82
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