Abstract
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Objectives: According to the World Health Organization, gaming disorder is now officially a medical condition that has been listed in most recently published International Classification of Diseases (ICD) 11. This is particularly true in children where 97% of teen boys and 83% of teen girls play video games, per the Pew Research Center. Kids and teens age 8 to 18 spend an average of more than seven hours a day looking at electronics resulting in steadily growing concerns about screen time. External occipital protuberance (EOP) is a midline bony prominence in the occipital bone that the ligamentum nuchae and trapezius muscle attach to its tip. The ligamentum nuchae Extends from the EOP on the skull and median nuchal line to the spinous process of C7 (Fig 1). Its function is to limit flexion and to provide an attachment for the trapezius and splenius capitis. The use of electronics leads to an extended period of neck hyperflexion resulting in a gradual chronic irritation which leads to exostosis at the EOP. These changes would result in a focus of increased MDP uptake in bone scanning that may mimic skull metastases. To the best of our knowledge, this is the first time that the frequent electronic use induces a false positive lesion in bone scanning is being reported. We documented the interval development of such lesion after few years of frequent gaming and electronic use (Figures 2-4). Therefore, EOP uptake may represent a common potential pitfall in staging and restaging pediatric patients undergoing bone scanning. This pictorial essay is to illustrate various representative cases with varieties of findings with different patterns of EOP uptake which would include mild and moderate uptake, focal and diffuse uptake, with and without cervical spine changes. Also, correct and careful interpretation of the CT scan as part of the SPECT/CT or PET/CT examination is of special importance in differentiating benign from malignant uptake. We will also show the appearance of some of these findings by other imaging modalities for further characterization.
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