Nuclear medicine imaging in pediatric oncology

Nuclear medicine imaging techniques, whether applied in the initial diagnosis or in assessing the response to therapy, are indispensable in the evaluation of malignant diseases that afflict infants and children. The major role of these techniques (bone, 67Ga and 201Tl scintigraphy, imaging with labeled leucocytes, immunoscintigraphy) is that of complementing, in an essential manner, other first choice diagnostic investigations (radiological, bioptic, etc.) such as in evaluating malignant skeletal tumors, soft tissue sarcomas, lymphomas, leukemia and histiocytosis X. Nevertheless, due to their high tissue specificity and/or diagnostic reliability, 99mTc-MDP (or analogues) imaging in the screening of bone metastases, 123/131I-MIBG scintigraphy in the diagnosis and management of neuroblastoma and 131I whole body scan in staging postoperatively differentiated thyroid cancers are proposed as first choice modalities. Well established (131I therapy) or recently developed (131I-MIBG therapy and radioimmunotherapy) therapeutic modalities are available today to be either integrated with or to substitute the conventional treatment of differentiated thyroid carcinoma and neuroblastoma.