title: Comparison of ultrasound and dimercaptosuccinic acid scintigraphy changes in acute pyelonephritis.
abstract: The strategy for morphological investigations in children with acute pyelonephritis (APN) remains debatable. We studied 70 children (median age 2.0 years) admitted with a first episode of pyelonephritis using a high-resolution ultrasound technique (RUS) and compared the results with 99m technetium-dimercaptosuccinic acid (DMSA) renal scintigraphy. The DMSA scan was abnormal in 62 children (89%). However, using a high-frequency transducer we found abnormal sonogram changes in 61 children (87%), consisting of an increased kidney volume in 42, and/or a thickening of the wall of the renal pelvis in 42, and/or a focal hyper- or hypoechogenicity in 36, and/or a diffuse hyperechogenicity in 31 children. Micturating cystourethrography was performed in all children, revealing vesicoureteral reflux (VUR) in 22 (31%). Among those children with VUR, 4 had a normal DMSA scan, 2 an abnormal RUS, and 2 a normal DMSA scan and RUS. Our data suggest that B-mode RUS performed with a high-frequency transducer by a trained radiologist is nearly as sensitive as the DMSA scan in diagnosing renal involvement in children with unobstructed APN and in predicting VUR.
authors.affiliation: Service de Pédiatrie, Hôpital Arnaud de Villeneuve, CHU Montpellier, France.
authors.forename: D
authors.initials: D
authors.lastname: Morin
authors.forename: C
authors.initials: C
authors.lastname: Veyrac
authors.forename: P O
authors.initials: PO
authors.lastname: Kotzki
authors.forename: C
authors.initials: C
authors.lastname: Lopez
authors.forename: F
authors.initials: F
authors.lastname: Dalla Vale
authors.forename: M F
authors.initials: MF
authors.lastname: Durand
authors.forename: J
authors.initials: J
authors.lastname: Astruc
authors.forename: R
authors.initials: R
authors.lastname: Dumas
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011704:Pyelonephritis / Q000000981:diagnostic imaging*; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014463:Ultrasonography; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging
chemical_list: D019783:Technetium Tc 99m Dimercaptosuccinic Acid