The value of Ga-67 renal SPECT in diagnosing and monitoring complete and incomplete treatment in children with acute pyelonephritis.
OBJECTIVE
This study evaluated the utility of Ga-67 renal SPECT for diagnosing acute pyelonephritis (APN) in children and monitoring them.


METHODS
Seventy-one children (ages 1 week to 12 years) who were thought clinically to have APN were included in the study. The disease was considered present if the patients had all of the following: fever (38.5 degrees C), pyuria (leukocyte counts/per high-power field > or = 10), and a positive result of a urinary culture or blood culture. Tc-99m DMSA, Ga-67 renal SPECT, and voiding cystourethrography were performed, with informed consent from the patients' parents, within 3 days after hospitalization. Three months after treatment, Tc-99m DMSA and Ga-67 renal SPECT were repeated in those patients who had abnormal results of the initial Ga-67 renal SPECT.


RESULTS
In the diagnostic study, Ga-67 renal SPECT was superior to DMSA renal SPECT in detecting lesions (97% vs. 79%). Three children had false-negative results with Ga-67 renal SPECT. Seventeen kidneys were negative with Tc-99m DMSA but positive with Ga-67 renal SPECT. No patients had any Ga-67 uptake on post-therapy imaging. However, 32 of 107 kidneys (30%) had permanent renal scars. In these 107 kidneys, 78 (73%) were associated with high-grade vesicoureteral reflux (VUR; VUR grade > or = 3) and 29 (27%) with low-grade or no VUR.


CONCLUSIONS
High-grade VUR tends to be associated more with APN than has been reported by others, probably because of an underestimation of APN by ultrasonography or DMSA. Ga-67 renal SPECT is sensitive and useful not only in diagnosis but also for monitoring and follow-up of children with clinical suspicion of APN, especially in those with equivocal results after DMSA renal SPECT studies.
Yen
T C
TC
Department of Nuclear Medicine, Chang Gung Memorial Hospital, Taipei Medical Center and School of Medicine, Chang Gung University, Taiwan.
Tzen
K Y
KY
Chen
W P
WP
Lin
C Y
CY
D000208:Acute Disease; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D005260:Female; D005710:Gallium Radioisotopes; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007275:Injections, Intravenous; D007668:Kidney / Q000000981:diagnostic imaging*; D008297:Male; D011446:Prospective Studies; D011704:Pyelonephritis / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D015899:Tomography, Emission-Computed, Single-Photon; D014567:Urography / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging
D005710:Gallium Radioisotopes; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid