Diagnosing Acute Pyelonephritis with CT, Tc-DMSA SPECT, and Doppler Ultrasound: A Comparative Study.
OBJECTIVE
With growing interest in early imaging, the aim of our study was to define the most practical modality for routine clinical use for the diagnosis of acute pyelonephritis (APN). We compared the sensitivity of enhanced computerized tomography (CT), dimercaptosuccinic acid (DMSA) scintigraphy, and Doppler ultrasonography (DUS) by using clinical findings as the standard of reference.


METHODS
A total of 207 APN patients (191 women, 16 men; mean age, 49.4 years; range, 17-88 years) were enrolled in this study. All the patients underwent imaging modalities during hospitalization. SPECT images were obtained 4 hours after injection of (99m)Tc-DMSA. Transverse and coronary CT images were obtained before and after injection of the contrast agent. DUS was performed in the longitudinal, transverse, and coronal planes. All the images were read independently by a single radiologist and a nuclear medicine specialist. The sensitivity of each modality for detecting APN was compared.


RESULTS
CT showed significantly superior sensitivity compared with that of DUS (81.0% vs. 33.3%, respectively, n=147). DMSA scintigraphy also showed significantly superior sensitivity compared with that of DUS (74.7% vs. 33.3%, respectively, n=150). Compared with DMSA scintigraphy, CT showed superior sensitivity, but the difference was not statistically significant (81.0% vs. 74.8%, respectively, n=147, p=0.163).


CONCLUSIONS
For cases of clinically suspected APN, CT and DMSA scintigraphy appear to be equally sensitive and reliable for detecting APN, although CT is more practical in various fields. DUS was significantly less sensitive.
Yoo
Je Mo
JM
Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Koh
Jun Sung
JS
Han
Chang Hee
CH
Lee
Su Lim
SL
Ha
U-Syn
US
Kang
Sung Hak
SH
Jung
Yun Seok
YS
Lee
Yong Seok
YS