RadioGraphics, Vol 18, 341-351, Copyright © 1998 by Radiological Society of North America
Pediatric skeletal scintigraphy: applications of pinhole magnification
LP Connolly, ST Treves, SA Connolly, RE Zimmerman, Z Bar-Sever, D Itrato and RT Davis
Department of Radiology, Children's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Pinhole magnification scintigraphy is an effective means of evaluating the
pediatric skeleton because it provides optimal high-resolution images. This
technique is indicated when diagnostic uncertainty persists after
high-resolution imaging with parallel hole collimation. Pinhole
magnification scintigraphy requires approximately 20 minutes of acquisition
time per image and meticulous attention to details such as choice of
pinhole insert, collimator positioning, and patient immobilization.
However, the technique is superior to planar imaging in demonstrating acute
osteomyelitis in bone adjacent to growth centers and epiphyseal involvement
that is either primary or the result of local spread of infection. In
addition, pinhole imaging has proved highly reliable in the early diagnosis
of Legg-Calve-Perthes disease and is useful in depicting osteonecrosis
related to specific causes such as corticosteroid treatment or trauma.
Scintigraphic manifestations of femoral head ischemia or infarction and
findings indicative of osteomyelitis associated with a hip effusion are
well demonstrated with pinhole imaging. This technique also helps
characterize osteoid osteomas and may be used intraoperatively to confirm
the complete excision of this benign tumor. Finally, pinhole magnification
scintigraphy clearly depicts fractures of the femoral neck and allows a
high degree of confidence in diagnosing injuries to the small bones of the
hands and feet.
