The Usefulness of 99mTc-DMSA Scan in Acute Pyelonephritis and Vesicoureteral Reflux in Children

Park, Kyung Ho; Lee, Kyung Yil; Lee, Hyung Shin; Kim, Sang Yong; Han, Ji Whan; Lee, Ik Jun; Hwang, Kyung Tae; Kwang, Si Won

Abstract

During a 4 year period, 118 children(62 boys) below 14 years of age(median 2.9+/-2.7 years) with symptomatic urinary tract infection were studied by 99mTc-dimercaptosuccinc acid scintigraphy(DMSA scan), ultrasonography and voiding cystoureterography(VCUG). The male to female ratio was 1.1 : 1, and 2.4 : 1 under 1 year of age, and 0.54 : 1 above 1 year age, respectively. Forty-seven patients presented with positive urine cultures and 71 were negative. DMSA scan was performed in 108 patients, and showed abnormalities in 50(46.3%) of them. Renal scars were observed in 24(51.0%) of 47 patients with positive urine culture and 26(42.6%) of 61 patients with negative urine culture, however there was no statistical difference between the two groups. Of the 118 patients VCUG was performed in 92 patients. Vesicoureteral reflux was found in 29(31.5%) of them. VURs were found in 25(50.0%) of 50 patients with positive and 4(9.6%) of 42 patients with negative findings in DMSA scan. Also, DMSA scan demonstrated scarring in 11(64.7%) of 17 renal units with grade I-II, 12(92.3%) of 13 renal units with grade III, and 9(90.0%) of 10 renal units with grade IV-V. The incidence of positive findings in DMSA scan was higher above grade III. VURs were found in 21 (52.5%) of 40 patients with abnormal findings in ultrasonography and 8(15.3%) of 52 patients with normal findings. Ultrasonographic findings were abnormal in 29(58.0%) of 50 patients with positive findings in DMSA scan and were normal in 47(81.0%) of 58 patients with negative findings. Our study shows that DMSA scan is useful in the diagnosis of acute pyelonephritis and detection of VUR. It is advisable that DMSA scan should be included as an initial evaluation tool for symptomatic urinary tract infection in children and used as a follow-up tool.