A new imaging modality in detection of caustic oesophageal injury: Technetium-99m pyrophosphate scintigraphy Burhan Aksu a, * , Gulay Durmus-Altun b , Funda Ustun b , Nese Torun b , Mehmet Kanter c , Hasan Umit d , Nejdet Sut e a Department of Pediatric Surgery, Faculty of Medicine, Trakya University, 22030 Edirne, Turkey b Department of Nuclear Medicine, Faculty of Medicine, Trakya University, Edirne, Turkey c Department of Histology and Embryology, Faculty of Medicine, Trakya University, Edirne, Turkey d Department of Gastroenterology, Faculty of Medicine, Trakya University, Edirne, Turkey e Department of Biostatistics, Faculty of Medicine, Trakya University, Edirne, Turkey Received 15 October 2008; received in revised form 18 November 2008; accepted 18 November 2008 Available online 4 January 2009 International Journal of Pediatric Otorhinolaryngology (2009) 73, 409—415 www.elsevier.com/locate/ijporl KEYWORDS Technetium-99m pyrophosphate scintigraphy; Caustic; Oesophageal injury; Corrosive Summary Objectives: Early oesophagoscopy is usually recommended in children after caustic ingestion to assess the severity of the initial digestive lesions. An oesophagoscopic procedure in children always demands to be performed under sedation and bears a certain risk of iatrogenic injury. The purpose of the study is to determine the value and sensitivity of Tc-99m pyrophosphate (99mTc-PYP) scintigraphy for the detection of caustic oesophageal injury. Methods: The caustic oesophageal burns were created with 25% NaOH in an experi- mental rat model. Seventeen rats were divided into two groups. The BURN group (n = 9) included caustic oesophageal burning rats. Non-BURN group (n = 8) included sham-operated rats. All animals underwent 99mTc-PYP scintigraphy 72 h after the burning experiment. Anterior static and single-photon emission computed tomogra- phy images were obtained using a low-energy all-purpose collimator, 2.55 zoom factor, 3h after intravenous injection of 10mCi 99mTc-PYP. After the imaging, all the oesophagi were explored for external determination of the injury sites and macroautoradiographic scintigraphy as well. Rectangular region of interest were placed in the visually determined lesion of oesophagus (O) as well as non-lesion area (N), and an ON ratio was created. The severity and extension of oesophageal burn were assessed 3 days after burning by histopathologic evaluation. The injuries were graded according to the ulcer depth, ulcer width, thrombus formation, and the development of perivascular fibrinoid necrosis. * Corresponding author. Tel.: +90 2842357641; fax: +90 2842352730. E-mail address: burhanfeyza@yahoo.com (B. Aksu). 0165-5876/$ — see front matter. Published by Elsevier Ireland Ltd. doi:10.1016/j.ijporl.2008.11.008