Korean J Urol.  2010 Apr;51(4):260-265.

Diagnosing Acute Pyelonephritis with CT, (99m)Tc-DMSA SPECT, and Doppler Ultrasound: A Comparative Study

• Yoo JM
• Koh JS
• Han CH
• Lee SL
• Ha US
• Kang SH
• Jung YS
• Lee YS

Abstract

PURPOSE
With growing interest in early imaging, the aim of our study was to define the most practical modality for routine clinical use for the diagnosis of acute pyelonephritis (APN). We compared the sensitivity of enhanced computerized tomography (CT), dimercaptosuccinic acid (DMSA) scintigraphy, and Doppler ultrasonography (DUS) by using clinical findings as the standard of reference. MATERIALS AND METHODS: A total of 207 APN patients (191 women, 16 men; mean age, 49.4 years; range, 17-88 years) were enrolled in this study. All the patients underwent imaging modalities during hospitalization. SPECT images were obtained 4 hours after injection of (99m)Tc-DMSA. Transverse and coronary CT images were obtained before and after injection of the contrast agent. DUS was performed in the longitudinal, transverse, and coronal planes. All the images were read independently by a single radiologist and a nuclear medicine specialist. The sensitivity of each modality for detecting APN was compared. RESULTS: CT showed significantly superior sensitivity compared with that of DUS (81.0% vs. 33.3%, respectively, n=147). DMSA scintigraphy also showed significantly superior sensitivity compared with that of DUS (74.7% vs. 33.3%, respectively, n=150). Compared with DMSA scintigraphy, CT showed superior sensitivity, but the difference was not statistically significant (81.0% vs. 74.8%, respectively, n=147, p=0.163). CONCLUSIONS: For cases of clinically suspected APN, CT and DMSA scintigraphy appear to be equally sensitive and reliable for detecting APN, although CT is more practical in various fields. DUS was significantly less sensitive.

Keyword

Diagnostic imaging; Pyelonephritis

MeSH Terms

Diagnostic Imaging
Female
Hospitalization
Humans
Nuclear Medicine
Pyelonephritis
Specialization
Succimer
Tomography, Emission-Computed, Single-Photon
Ultrasonography, Doppler
Succimer

Figure

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  FIG. 1 (A) The coronary spiral CT scan obtained after intravenous administration of contrast agent demonstrates well-defined foci (arrows) of decreased attenuation in the lower pole of the right kidney. (B) A large area of parenchymal hypo-attenuation in the posterior aspect of the right kidney (arrow).

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  FIG. 2 (A) Dimercaptosuccinic acid (DMSA) scintigraphy demonstrates decreased uptake in the upper half and the lower portion of the right kidney (arrows). (B) The transverse images show a more accurate area of decreased uptake in the right kidney, especially in the anterior and the posterior aspect of the right kidney (arrows).

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  FIG. 3 (A) Renal Doppler ultrasonography (DUS) shows mild swelling and a wedge-shaped hypoechoic focus (arrow) of the right kidney related to acute pyelonephritis. (B) The color flow DUS image demonstrates diminished flow through the involved area (arrow).

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