Identification of new renal scarring in repeated episodes of acute pyelonephritis using Tc-99m DMSA renal SPECT

Citation
Tc. Yen et al., Identification of new renal scarring in repeated episodes of acute pyelonephritis using Tc-99m DMSA renal SPECT, CLIN NUCL M, 23(12), 1998, pp. 828-831
Citations number
22
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Radiology ,Nuclear Medicine & Imaging
Journal title
CLINICAL NUCLEAR MEDICINE
ISSN journal
0363-9762 → ACNP
Volume
23
Issue
12
Year of publication
1998
Pages
828 - 831
Database
ISI
SICI code
0363-9762(199812)23:12<828:IONRSI>2.0.ZU;2-3
Abstract
Purpose: This prospective study compared the value of Tc-99m DMSA renal pla nar scintigraphy with SPECT to detect new renal involvement in patients wit h repeated episodes of acute pyelonephritis (APN). Materials and Methods: Children with suspected APN were transferred to our department for DMSA renal scans. Seventy-two children (ages 1 week to 15 ye ars) had DMSA planar and SPECT imaging performed twice because of clinical or laboratory suspicion of repeated APN. In addition, radiographic voiding cystourethrography was also performed in all cases. The presence of vesicou reteral reflux (VUR) was graded on a scale of 0 to 5. Results: New lesions were observed with SPECT in 56 kidneys and with planar scintigraphy in 38 kidneys. No patients had a negative result of Tc-99m DM SA renal SPECT who also had a positive Tc-99m DMSA planar result. The degre e of VUR as related to APN was diagnosed better with SPECT than with planar scintigraphy (46 compared with 30 and 10 compared with 8, respectively). T here is a significant difference (P < 0.05) between the diagnostic ability of these two methods to identify the increased tendency of repeated APN to occur with high-grade VUR compared with low-grade or no VUR. Conclusions: High-grade VUR is more commonly associated with renal injury t han is low-grade or no VUR. If only Tc-99m DMSA renal planar scintigraphy i s performed, renal scarring may be underestimated. Our results suggest that Tc-99m DMSA renal SPECT, rather than planar scintigraphy, should be used r outinely in children with a clinical suspicion of APN, especially for those with scarred kidneys and high-grade VUR.