What is the role of bone scintigraphy in Wilms tumor imaging?

Updated: Mar 04, 2019
  • Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Bone scintigraphy is a sensitive means for detecting bony metastases. Bone scanning is necessary in children with clear cell sarcoma. If the clear cell variant of Wilms tumor is present on postsurgical pathologic analysis, a bone scan is obtained to look for spread to bone. Spread to the bone is unusual for other types of Wilms tumors. Bony metastases of osteoblastic Wilms tumors may be photon deficient. If small, they may be missed on isotope bone scans. [14]

Radionuclide studies performed with technetium-99m DMSA may be indicated to assess the volume of functioning renal tissues and thus guide what tissue may be preserved when nephron-preserving surgery of bilateral tumors is being contemplated. Isotopic renography is a sensitive technique for assessing renal function. Gallium-67 citrate appears to be a highly valuable radionuclide that may be used to differentiate an infectious process in the kidney from nephroblastomatosis. [39]

Wilms tumors appear to concentrate 18F-fluorodeoxyglucose (FDG), a feature that might prove clinically useful. [40, 41] Shulkin et al examined 3 patients with known or suspected Wilms tumor who underwent imaging with FDG-PET, [42] and in all 3 patients the results of the PET scans influenced the therapeutic decisions. The investigators concluded that FDG-PET scanning may be useful for managing Wilms tumors in selected patients.

Nuclear medicine plays an important and increasing role in the management of solid childhood tumors. It is also helpful in managing the complications of cancer treatment, such as the infections often associated with immunosuppression in oncology patients.

Scintigraphy is a complementary investigation to other radiologic techniques and adds a functional element to anatomic cross-sectional imaging. Scintigraphy is used in the initial diagnosis, staging, and assessment of tumoral responses to treatment. It also aids in detecting recurrence and in diagnosing complications. Scintigraphy has a role in the differential diagnosis of Wilms tumors, in their staging, and in imaging therapy-related complications.

Lepanto et al examined 20 pediatric patients with malignant disease using whole-body gallium scans. [43] Of 50 sites studied, true-positive results were found in 17%, and false-negative results were noted in 58%. The method served best in patients with Hodgkin disease, in whom the true-positive rate was 64%. In no instance did the results of gallium scanning affect the clinical care of a patient.

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