Incidence of 99Tc-MDP uptake in the external occipital protuberance in the pediatric population: the new normal?

Background: Children and young adults have a vast array of electronics at their fingertips. While it can provide endless hours of entertainment and education, we are also seeing a structural consequence. Children are using these devices with their head tilted down with poor posture resulting in increased stress on the skull from attached structures which can lead to a bone spur (exostosis) at the external occipital protuberance (EOP). While typically painless, it can progress to necessitate surgical intervention. Objectives: The purpose of this study is to understand the prevalence of exostosis at the EOP and how the finding can affect the nuclear medicine bone scan. Materials and methods: 43 pediatric patients who underwent a whole-body bone scan over a period of 1 year were included in the study (10-19 years old). Images were reviewed by 2 board-certified Nuclear Medicine physicians to assess for uptake midline in the occipital skull. Suspected cases were followed up with all available clinical and radiographic reports and images. Results: Bone scan demonstrated an occipital focus of uptake in 7 (16%) of the 43 patients (5 males and 2 females with a mean age of 15 years; range 10-19). Of these, 5/7 (71%) were confirmed by additional imaging. Conclusion: The rapidly advancing technology is leading to increased screen time in children and young adults. Our study shows that 16% of the pediatric population imaged at our facility between the ages of 10-19 years have signs of exostosis at the EOP. It is particularly important for clinicians to be aware of this entity when reading bone scans to avoid false positive interpretations.