Lung Ventilation/Perfusion Single Photon Emission Computed Tomography (SPECT) in Infants and Children with Nonembolic...

Single photon emission computed tomography (SPECT) provides high contrast three dimensional images of the regional distribution of a radiotracer. SPECT is a widely used technique in pulmonary investigations of the ventilation (V) and perfusion (Q) in the adult patient, mainly in the diagnosis of pulmonary embolism. However, safety concerns among practitioners due to radiation exposure and the use of macroaggregate albumin for the perfusion scan have historically precluded the use of SPECT in pediatric patients with nonembolic pulmonary disorders. Additionally, patient cooperation at ventilation tracer administration and image artifacts from patient movements due the long acquisition times, have further limited the application of SPECT in pediatric patients. With the introduction of technegas aerosol for ventilation studies and the use of high sensitive multihead gamma cameras, both the total amount of administered activity and acquisition time have drastically been reduced allowing the application of SPECT in pediatric patients. Modern hybrid gamma camera/computed tomography systems (SPECT/CT) also brings the possibility of adding a fully diagnostic CT to the SPECT images, incrementing the clinical value of the investigation. Besides pulmonary embolism, there is now some clinical evidence that lung SPECT has diagnostic value in several pulmonary pathologies causing V/Q mismatching, which are specific to the pediatric age group. In this work, we will exemplify and briefly discuss some of these applications based on the literature and our routine clinical experience. Consideration to the risks and safety aspects associated to performing pediatric V/Q SPECT are also discussed.