Pediatrik Hastalıklarda Tanısal Nükleer Tıp Uygulamaları: Güncel Yaklaşım ve Yenilikler
Synopsis
This review comprehensively examines the current application areas, clinical approaches, and innovations of diagnostic nuclear medicine applications in pediatric diseases. In pediatric nephrourology, while 99mTc-DMSA scintigraphy offers high sensitivity in detecting renal cortical scars and parenchymal damage, 99mTc-MAG3 dynamic renal scintigraphy provides detailed information about renal perfusion, tubular function, and urinary excretion, delivering reliable results in evaluating vesicoureteral reflux (VUR) and pelvic stenosis. Additionally, dynamic scintigraphy with captopril is used in diagnosing renovascular hypertension, whereas DMSA and MAG3 are utilized to demonstrate parenchymal function and stasis in congenital fusion anomalies such as duplex collecting systems and horseshoe kidneys. In endocrine applications, Tc-99m pertechnetate thyroid scintigraphy is the most accurate method for determining gland location and differentiating thyroid dysgenesis from dishormonogenesis in infants with congenital hypothyroidism. In the gastrointestinal system, gastric emptying scintigraphy is employed for motility disorders, while 99mTc-pertechnetate Meckel's diverticulum scintigraphy detects ectopic gastric mucosa bleeding with 90% accuracy. In cases of fever of unknown origin, inflammatory bowel diseases, and vasculitis, 18F-FDG PET-CT and radiolabeled leukocyte scintigraphy assist in identifying the focus, whereas in drug-resistant epilepsy, ictal/interictal SPECT and PET-MR/PET-CT localize the epileptic focus with high accuracy. In pediatric oncology, I-123 MIBG scintigraphy is successfully preferred for neuroblastoma diagnosis and staging, while 18F-FDG PET-CT and Gallium-68 labeled agents are utilized for metabolic characterization and monitoring treatment response in lymphomas and sarcomas.
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