title: Accuracy of early DMSA scan for VUR in young children with febrile UTI.
abstract: OBJECTIVE
  To evaluate the accuracy of an acute (99m)Tc-dimercaptosuccinic acid (DMSA) scan in predicting dilating vesicoureteral reflux (VUR) among young children with a febrile urinary tract infection (UTI).
  
  
  METHODS
  The medical records of children (≤ 2 years of age), presenting with febrile UTI between January 2000 and December 2011, were retrospectively reviewed.
  
  
  RESULTS
  A total of 523 children were included in this study, of whom 397 children (75.9%) had abnormal DMSA results and 178 children (34.0%) were identified as VUR on micturating cystourethrography (MCU). Among all the patients, the number of children with dilating VUR was 151 (28.9%). The rate of abnormal results on DMSA for the dilating VUR group was significantly higher than the rates for the non-VUR and low-grade VUR groups (P < .01). In the <6 months age group and ≥ 6 months age group, the sensitivities of DMSA in predicting dilating VUR were 96.15% and 100.0%, respectively, the negative predictive values were 97.26% and 100.0%, respectively, and the negative likelihood ratios were 0.0911 and 0.0000, respectively.
  
  
  CONCLUSIONS
  For children ≤ 2 years of age with a febrile UTI, an acute DMSA scan is valuable in the exclusion of dilating VUR. The likelihood of the presence of dilating VUR on MCU is rather low when the result of DMSA is negative. DMSA should be conducted to assess the need for an MCU.
authors.affiliation: Department of Nephrology and Rheumatology, Children's Hospital of Fudan University, 399 WanYuan Rd, Shanghai 201102, China. hxu@shmu.edu.cn.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhang
authors.forename: Hong
authors.initials: H
authors.lastname: Xu
authors.forename: Lijun
authors.initials: L
authors.lastname: Zhou
authors.forename: Qi
authors.initials: Q
authors.lastname: Cao
authors.forename: Qian
authors.initials: Q
authors.lastname: Shen
authors.forename: Li
authors.initials: L
authors.lastname: Sun
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Fang
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.forename: Yihui
authors.initials: Y
authors.lastname: Zhai
authors.forename: Jia
authors.initials: J
authors.lastname: Rao
authors.forename: Mier
authors.initials: M
authors.lastname: Pa
authors.forename: Ruifang
authors.initials: R
authors.lastname: Zhao
authors.forename: Yunli
authors.initials: Y
authors.lastname: Bi
mesh_terms: D002675:Child, Preschool; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; 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
keywords: DMSA; MCU; UTI; VUR