99mTc ethylene dicysteine scintigraphy for diagnosing cortical defects in acute pyelonephritis: a comparative study with 99mTc dimercaptosuccinic acid.
OBJECTIVE
To evaluate the clinical usefulness of early cortical phase images in the diagnosis of acute pyelonephritis and to compare the measurements of differential renal function obtained by both 99mTc ethylene dicysteine (99mTc-EC) and 99mTc dimercaptosuccinic acid (99mTc-DMSA).


METHODS
Forty-three children who had undergone both 99mTc-EC and 99mTc-DMSA studies within 5 days of acute infection were studied. Cortical images of 99mTc-EC were obtained by the sum of the renogram frames achieved between the first 60-120 s of the renogram study. DMSA and EC images were visually interpreted using four points of semiquantitative ratings: 0, normal; 1, mild hypoactivity; 2, moderate hypoactivity with partial loss of margins; 3, marked hypoactivity with loss of cortical margins. Values for the differential renal function were obtained for both studies.


RESULTS
DMSA detected a total of 109 lesions in 36 patients and EC detected 90 lesions with a sensitivity of 82.5%. 99mTc-EC successfully detected moderate-to-severe cortical lesions but was less effective with mild lesions (sensitivity 60%). Bland-Altman analysis demonstrated good agreement among the results for differential renal function (95% CI -0.26 to 0.96).


CONCLUSIONS
99mTc-EC early phase images detected most of the cortical lesions. Its sensitivity depends on the severity of the lesions. EC provided reliable information in the estimation of differential renal function.
Department of Nuclear Medicine, Gazi University Medical Faculty, 06450 Oran Sitesi, Ankara, Turkey. atasever@gazi.edu.tr
Tamer
T
Atasever
Ozan
O
Ozkaya
Evrim
E
Abamor
Oğuz
O
Söylemezoğlu
Necla
N
Buyan
Mustafa
M
Unlü
D002648:Child; D002675:Child, Preschool; D003545:Cysteine / Q000031:analogs & derivatives*; D005260:Female; D006801:Humans; D007223:Infant; D007672:Kidney Cortex / Q000000981:diagnostic imaging*; D007677:Kidney Function Tests / Q000379:methods; D007681:Kidney Papillary Necrosis / Q000145:classification* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008297:Male; D015609:Organotechnetium Compounds; D011866:Radioisotope Renography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D019783:Technetium Tc 99m Dimercaptosuccinic Acid
D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C073806:technetium Tc 99m-ethylenedicysteine; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D003545:Cysteine