Recent advances in pediatric nuclear medicine.

This review is devoted to some controversial topics in the field of pediatric nuclear medicine. In most cases, drug sedation can be avoided and the nuclear medicine procedure can be successfully achieved simply by taking the emotional life of the child into account. Factors such as past negative experiences (painful procedures, hospitalizations), unfamiliar environment (frightening examination room), physical aggressions related to the nuclear medicine procedure (intravenous injections, cystography), and the feeling of loss of parents' protection all contribute to the child's anxiety. People in charge of pediatric procedures should be adequately trained to be aware of these factors and to create the best environmental conditions to avoid unnecessarily frightening the child. Methods for measuring renal clearance in children are numerous. It is my aim to review the different methods proposed in the literature, including the nonradioisotopic methods, the reference radioisotopic methods, the various simplified algorithms using blood samples, and the gamma-camera methods. Gastroesophageal reflux scintigraphy is a well-established procedure for the detection of gastro-esophageal reflux in children. However, despite the numerous advantages of this technique, it has not gained wide acceptance in the field of pediatric gastroenterology. This review focuses mainly on the comparison between scintigraphy and pH metry. Finally, the applications of 99m technetium-hexamethylpropylenamine brain single photon emission computer tomography in the field of pediatric neurology are still under development; this part of the review is an attempt to summarize the real contribution of this technique.