Limitations of 99mTc-DMSA scan in diagnosing acute pyelonephritis in children.
10.3345/kjp.2010.53.3.408
- Author:
Byung Gee KIM
1
;
Jae Ryoung KWAK
;
Ji Min PARK
;
Ki Soo PAI
Author Information
1. Department of pediatrics, Ajou University School of Medicine, Suwon, Korea. kisoopai@ajou.ac.kr
- Publication Type:Original Article
- Keywords:
Acute pyelonephritis;
64-Channel computed tomography;
99mTc-DMSA scintigraphy;
Children;
Infancy
- MeSH:
Abdomen, Acute;
Blood Sedimentation;
C-Reactive Protein;
Child;
Fever;
Gamma Cameras;
Humans;
Infant;
Leukocytes;
Male;
Prevalence;
Pyelonephritis;
Succimer;
Technetium Tc 99m Dimercaptosuccinic Acid
- From:Korean Journal of Pediatrics
2010;53(3):408-413
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: We aimed to prove the relative limitation of 99mTc-DMSA scintigraphy (DMSA) compared to computed tomography (CT) in diagnosing acute pyelonephritis (APN) in children. METHODS: Since September 2006, after a 64-channel CT was imported, 10 DMSA false-negative patients have been identified: these patients underwent a CT scan for acute abdomen or acute febrile symptoms and were diagnosed as having APN; however, their DMSA scans were clear. We focused on these 10 DMSA false-negative patients and analyzed their clinical findings and CT results. We used Philips Brilliance Power 64-channel CT scanner for the CT scan and Siemens Orbitor Nuclear Camera 60 Hz for the DMSA scan. RESULTS: The 10 DMSA false-negative patients were mostly males (80%) and infants (80%). They had fever for a mean of 1.1-day duration before admission and showed increase in acute reactants: leukocyte, erythrocyte sedimentation rate, and C-reactive protein. The CT findings of renal lesions were focal in 6 (60%) cases and diffuse in 4 (40%) cases, and most of the lesions were unilateral in 80% of patients. CT proved that 22 renal lesions were neglected by DMSA. Differential renal function test by DMSA was also of no use in the evaluation of renal lesions. CONCLUSION: In this study, DMSA scan showed limitation in finding renal cortical lesions of CT-proven APN patients. DMSA false-negative results seem to occur at early-phase disease of infantile age, but more prospective studies are needed to determine the reasons and their prevalence.
