title: DMSA scan for revealing vesicoureteral reflux in young children with urinary tract infection.
abstract: OBJECTIVE
  The objective of this study was to assess the ability of acute dimercaptosuccinic acid (DMSA) scintigraphy for revealing vesicoureteral reflux (VUR) in young children after a first febrile urinary tract infection (UTI).
  
  
  METHODS
  Children aged<or=24 months and were admitted with a first febrile UTI during a 5-year period were evaluated. The ability of acute DMSA scintigraphy to reveal dilating (grades 3-5) or severe (grades 4-5) VUR was assessed by comparing DMSA scan findings with those of voiding cystourethrography.
  
  
  RESULTS
  Of the 296 children included, 46 had dilating and 25 severe VUR. Abnormal DMSA scan results were associated with an odds ratio of 4.36 for dilating and 5.50 for severe VUR. For detecting dilating VUR, the area under the curve (AUC) was 0.68, the positive likelihood ratio (LR) was 2.00, and the negative LR was 0.46; for severe VUR, those values were 0.69, 2.10, and 0.38, respectively. Children with abnormal DMSA scan results combined with abnormal ultrasonography had an odds ratio of 3.60 for dilating and 6.32 for severe VUR. Despite normal findings on both investigations, 12 children had dilating and 4 severe VUR. For dilating VUR, the area under the (AUC) was 0.65, the positive LR was 1.70, and the negative LR was 0.47; for severe VUR, the values were 0.69, 1.90, and 0.29, respectively.
  
  
  CONCLUSIONS
  Our data suggest that acute DMSA scintigraphy has limited overall ability in identifying VUR and should not be endorsed as replacement for voiding cystourethrography in the evaluation of young children with a first febrile UTI.
authors.affiliation: University Hospital of Patras, Department of Pediatrics, Rio, Patras, 265 04, Greece. sfouzas@gmail.com
authors.forename: Sotirios
authors.initials: S
authors.lastname: Fouzas
authors.forename: Erifyli
authors.initials: E
authors.lastname: Krikelli
authors.forename: Pavlos
authors.initials: P
authors.lastname: Vassilakos
authors.forename: Despoina
authors.initials: D
authors.lastname: Gkentzi
authors.forename: Dimitrios A
authors.initials: DA
authors.lastname: Papanastasiou
authors.forename: Christos
authors.initials: C
authors.lastname: Salakos
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000209:etiology*; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000000981:diagnostic imaging*
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid