title: Acute phase 99mTc-dimercaptosuccinic acid scan in infants with first episode of febrile urinary tract infection.
abstract: BACKGROUND
  99mTc-dimercaptosuccinic acid (DMSA) scan is the golden standard for the diagnosis of acute pyelonephritis and renal scaring. We investigated the use of acute phase DMSA scan in infants presented promptly to the hospital because of the first episode of their febrile urinary tract infection (UTI).
  
  
  METHODS
  Ninety-eight infants with microbiologically confirmed first episode of febrile UTI were studied. DMSA scans were carried out within 7 days in these infants after admission. Infants with an abnormal acute DMSA scan underwent a second DMSA scan 6-12 months later.
  
  
  RESULTS
  Overall, acute DMSA scan was abnormal in 16 (16.3%) of the 98 patients. There were no differences in sex, age, fever over 38.5°C, blood inflammation indices, or evidence of vesicoureteral reflux (VUR) between patients with normal and abnormal acute DMSA scan (P>0.05). However, infants with grade III to V VUR as well as those with delayed treatment presented significantly increased renal involvement by acute DMSA scan (P<0.05). The sensitivity and specificity of abnormal acute DMSA scan to predict grade III to V VUR were 50% and 88% respectively. Its positive and negative likelihood ratios were 4.16 and 0.57, respectively. Of 16 children with abnormal initial DMSA scan results, 14 underwent a second DMSA scan. Follow-up DMSA scans were normal in 12 of the 14 children.
  
  
  CONCLUSIONS
  Parenchymal damage found in a minority of infants with febrile UTI presented promptly to the hospital. Acute phase DMSA scan should be carried out only in selected patients. An abnormal acute DMSA scan is a moderate predictor for dilated VUR and its ability to exclude VUR is restricted.
authors.affiliation: 1st Pediatric Department, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece. nprintza@in.gr
authors.forename: Nikoleta
authors.initials: N
authors.lastname: Printza
authors.forename: Evagelia
authors.initials: E
authors.lastname: Farmaki
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Piretzi
authors.forename: George
authors.initials: G
authors.lastname: Arsos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kollios
authors.forename: Fotios
authors.initials: F
authors.lastname: Papachristou
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D005260:Female; D005334:Fever / Q000382:microbiology; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011704:Pyelonephritis / Q000000981:diagnostic imaging; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000382:microbiology; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid