Bone scintigraphy in non-neoplastic diseases in children

Since the introduction of 99mTc labeled polyphosphates bone scintigraphy has become a widely accepted method for the evaluation of non-neoplastic bone diseases in children. High quality images require the child's immobilisation and a correct positioning as well as an optimized technical equipment. Two or three phase scintigraphy is the routinely procedure but additional techniques like pinhole images or SPECT can be very helpful for special indications and localisations. Due to the age and sex dependent differences of bone metabolism in the developing skeleton the interpretation of the bone scan in children is more difficult than in adults and requires more experience. Infections, trauma and aseptic necrosis are the most important non-neoplastic diseases requiring bone scintigraphy. Bone scan has a high sensitivity in the early detection of pathological bone metabolism indicating bone disease; other investigations, which are describing morphological changes like X-ray are less sensitive especially at the beginning of the disease. Negative bone scan rools out significant bone disorders with a high certainty. Follow-up studies can give additional informations about the response to therapeutical regimes and about the prognosis. To improve the specificity of a bone scan a combined interpretation of scintigraphy and X-ray is recommended.