Update on pediatric nuclear medicine in acute care.

There are various radiopharmaceuticals and hybrid imaging techniques for evaluating pediatric patients in the acute care setting. The focus of this article is on common nuclear medicine applications in pediatric acute care. Brain scintigraphy is an important ancillary test for evaluation of brain death/death by neurologic criteria when the clinical examination or apnea test cannot be safely or completely performed. Ventilation-perfusion scintigraphy is considered as a safe and useful test for suspected pulmonary embolism in hemodynamically stable children, especially when the chest radiograph is normal or near normal and radiation reduction is important. 99mTc-pertechnetate scintigraphy is stated to be the best noninvasive nuclear medicine test for detecting ectopic gastric mucosa in Meckel's diverticulum, whereas 99mTc-labeled red blood cell scintigraphy is useful for evaluating active or intermittent lower gastrointestinal bleeding from different causes. Hepatobiliary scintigraphy provides functional assessment of biliary excretion and is useful for evaluation of acute cholecystitis, choledochal cysts, and bile leaks. 99mTc-DMSA renal cortical scintigraphy is a sensitive method for detecting acute pyelonephritis and renal cortical scarring, while 99mTc-MAG3 renal scintigraphy is used to evaluate early and late complications of renal transplantation. Bone scintigraphy is considered as a valuable imaging modality for evaluation of osteomyelitis, occult fracture, stress injury, sickle cell related bone pain, and selected cases of suspected physical abuse, especially when whole body assessment is needed. 18F-FDG PET/CT has an increasing role in selected children with fever of unknown origin and inflammatory disorders. Moving forward, continued refinement of pediatric administered activities, wider use of SPECT/CT and PET-based imaging and updated pediatric-specific guidelines are expected to further improve the role of nuclear medicine in acute pediatric care.