Technetium-99m-DMSA renal SPECT in diagnosing and monitoring pediatric acute pyelonephritis.
This study compares the sensitivity of 99mTc-dimercaptosuccinic acid (DMSA) renal SPECT with planar scintigraphy, concluding the importance of 99mTc-DMSA renal SPECT for the early diagnosis of acute pyelonephritis (APN) in patients under 3 yr of age.


METHODS
Twenty-seven children under 3 yr of age, with clinical and/or laboratory suspicion of APN, were investigated. All 99mTc-DMSA renal SPECT and planar images and voiding cystoureterogram (VCUG) were obtained within 3 days of hospitalization.


RESULTS
In the first examination, renal cortical defects were detected in 23 patients (42 kidneys) with SPECT and in 9 patients (11 kidneys) with planar scintigraphy. One year after treatment, constant renal cortical lesions were observed in 11 patients (14 kidneys) with SPECT and 4 patients (4 kidneys) with planar scintigraphy. The high grades of vesicoureteral reflux (VUR) (grade >or= 3) correlate better with APN diagnosed by SPECT (34 kidneys) than by planar scintigraphy (8 kidneys). Multiple renal cortical defects (number of lesions >or= 4) were only seen in patients under 1.5 yr old and none of those with a negative 99mTc-DMSA renal SPECT had a positive 99mTc-DMSA renal planar scintigraphy at any time. There is a significant difference (p < 0.05) between the diagnostic ability of these two methods of examination.


CONCLUSIONS
Our results suggest that 99mTc-DMSA renal SPECT should be used, where possible, instead of planar DMSA in routine examination of children with clinical suspicion of APN, especially for those under 3 yr of age.
Yen
T C
TC
Department of Nuclear Medicine, Veterans General Hospital-Taipei, National Yang-Ming University, Taiwan.
Chen
W P
WP
Chang
S L
SL
Liu
R S
RS
Yeh
S H
SH
Lin
C Y
CY
D000208:Acute Disease; D002648:Child; D002675:Child, Preschool; D003973:Diatrizoate; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging*; D007672:Kidney Cortex / Q000000981:diagnostic imaging; D015609:Organotechnetium Compounds; D011704:Pyelonephritis / Q000000981:diagnostic imaging*; D011859:Radiography; D012680:Sensitivity and Specificity; D004113:Succimer; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D015899:Tomography, Emission-Computed, Single-Photon; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging
D015609:Organotechnetium Compounds; D003973:Diatrizoate; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D004113:Succimer