title: Comparison of magnetic resonance urography to dimercaptosuccinic acid scan for the identification of renal parenchyma defects in children with vesicoureteral reflux.
abstract: OBJECTIVE
  The objective of this study was to compare the accuracy of dimercaptosuccinic acid (DMSA) renal scan to magnetic resonance urography (MRU) in the identification of renal parenchyma defects (RPD).
  
  
  METHODS
  Twenty-five children with history of acute pyelonephritis and vesicoureteral reflux underwent DMSA scan and MRU to determine the presence of RPD. DMSA scans and MRUs were each evaluated by two radiologists and agreement achieved by consensus. Discordant DMSA-MRU findings were re-evaluated in a side-by-side comparison and an ultimate consensus reached.
  
  
  RESULTS
  The ultimate consensus diagnosis was 18 kidneys with RPDs in 15 patients, of which five were classified as mild RPDs, six as moderate RPDs, and seven as severe RPDs. Although DMSA scan and MRU were similar in their ability to diagnose RPDs, MRU was considered to represent the true diagnosis in 11 of the 12 discordant cases in consensus review by four pediatric radiologists. MRU showed a much higher inter-observer agreement with a weighted kappa of 0.96 for both kidneys compared to 0.71 for the right kidney and 0.86 for the left kidney by DMSA scan.
  
  
  CONCLUSIONS
  Our results suggest that MRU is superior to DMSA scan in the identification of renal parenchyma defects.
authors.affiliation: Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30342, USA. Electronic address: wcerwinka@gaurology.com.
authors.forename: W H
authors.initials: WH
authors.lastname: Cerwinka
authors.affiliation: Department of Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Grattan-Smith
authors.affiliation: Department of Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Jones
authors.affiliation: Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
authors.forename: M
authors.initials: M
authors.lastname: Haber
authors.affiliation: Department of Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA.
authors.forename: S B
authors.initials: SB
authors.lastname: Little
authors.affiliation: Department of Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Blews
authors.affiliation: Department of Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, GA 30342, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Williams
authors.affiliation: Department of Pediatric Urology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA 30342, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Kirsch
mesh_terms: D002675:Child, Preschool; D002921:Cicatrix / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D011704:Pyelonephritis / Q000175:diagnosis* / Q000209:etiology; D011856:Radiographic Image Enhancement / Q000379:methods; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D004113:Succimer; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014567:Urography / Q000379:methods; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis*
chemical_list: D004113:Succimer
keywords: DMSA scan; Magnetic resonance urography; Renal scarring; Vesicoureteral reflux