Normal dimercaptosuccinic acid scintigraphy makes voiding cystourethrography unnecessary after urinary tract infection.
OBJECTIVE
To test the hypothesis that infants with dilating vesicoureteral reflux (VUR) have abnormal acute dimercaptosuccinic acid (DMSA) scintigraphy results, as was suggested by an earlier retrospective study.


METHODS
We conducted a prospective study of infants <1 year old with first diagnosed symptomatic urinary tract infection at the Children's Hospital of Göteborg, Sweden. Two hundred ninety consecutive children (161 boys and 129 girls) with complete records were examined. Renal ultrasound scanning and DMSA scintigraphy were performed within a few days from diagnosis, and VCU was performed within 2 months.


RESULTS
VUR was found in 52 children, of which 27 had dilating VUR (grade III-V). DMSA scintigraphy results were abnormal in 149 infants (51%), 105 of 238 (44%) without VUR, 18 of 25 (72%) with VUR grade I to II, and 26 of 27 (96%) with VUR grade III to V (P <.001).


CONCLUSIONS
DMSA scintigraphy results were abnormal in all 27 infants with dilating VUR except 1. This single false-negative finding should be compared with 140 unnecessary VCU investigations. This supports our hypothesis that DMSA scintigraphy results are abnormal when there is dilating VUR. Thus, a normal DMSA scan makes VCU unnecessary in the primary examination of infants with UTI.
Department of Pediatrics, The Queen Silvia Children's Hospital, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
Iulian
I
Preda
Ulf
U
Jodal
Rune
R
Sixt
Eira
E
Stokland
Sverker
S
Hansson
D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007223:Infant; D016013:Likelihood Functions; D008297:Male; D011446:Prospective Studies; D011877:Radionuclide Imaging / Q000379:methods; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging* / Q000209:etiology; D014567:Urography; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000000981:diagnostic imaging*
D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid