Diagnostic accuracy of Tc-99m DMSA scintigraphy and renal ultrasonography for detecting renal scarring and relative function in patients with spinal dysraphism.
OBJECTIVE
To study additional benefits of performing Tc-99m dimercaptosuccinic acid (Tc-99m-DMSA) scintigraphy as part of the follow-up of adults with spinal dysraphism (SD), compared with ultrasonography, with regard to finding renal scarring and difference in split renal function.


METHODS
Between January 2011 and April 2013 every patient visiting our specialized outpatient clinic for adults with SD was invited to undergo both renal ultrasonography and Tc-99m-DMSA scintigraphy. Outcomes of both modalities were compared, with focus on renal scarring. The relation between renal scarring and hypertension was also assessed.


RESULTS
In total, 122 patients (with 242 renal units) underwent both renal scintigraphy and ultrasonography. More scars were seen on DMSA scintigraphy than on ultrasonography: 45.9% vs. 10.3% of renal units; P < 0.001. Renal scarring seen on DMSA was associated with the presence of hypertension (P = 0.049) whereas scarring seen on ultrasonography was not (P = 0.10). If ultrasonography was difficult to interpret, many more scars were missed on ultrasonography (78.9%) compared with easily interpretable ultrasonographic images (30.6%; P < 0.001).


CONCLUSIONS
In adults with SD, ultrasonography is of value to diagnose dilatation and stones of the upper urinary tract; however, compared with DMSA renography, renal scars are often missed, especially when the ultrasound is difficult to interpret.
Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
Paul W
PW
Veenboer
Division of Image, Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Monique G G
MG
Hobbelink
Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
J L H
JL
Ruud Bosch
Department of Pediatric Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
Pieter
P
Dik
Department of Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Floris W A
FW
van Asbeck
Department of Pediatric Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Frederik J A
FJ
Beek
Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
Laetitia M O
LM
de Kort
D000328:Adult; D001794:Blood Pressure; D002921:Cicatrix / Q000000981:diagnostic imaging; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006977:Hypertension, Renal / Q000000981:diagnostic imaging; D007668:Kidney / Q000000981:diagnostic imaging*; D007669:Kidney Calculi / Q000000981:diagnostic imaging; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D016135:Spinal Dysraphism / Q000000981:diagnostic imaging*; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014463:Ultrasonography; D055815:Young Adult
D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid
DMSA; neurogenic bladder; scintigraphy; sensitivity and specificity; spina bifida; ultrasonography; ultrasound