OBJECTIVETo evaluate the efficacy of (99m)Tc-dimercaptosuccinic acid (DMSA) scanning in predicting vesicoureteral reflux (VUR) among young children with febrile urinary tract infection (UTI) and to investigate the priority in applying either micturating cystourethrography (MCU) or DMSA.

METHODSThe medical records of children (age < or = 2 years), presenting with febrile UTI between January 2000 and December 2009, were retrospectively reviewed. All cases underwent DMSA renal scan within 1 week after diagnosis and MCU within 1 week after infection. According to the results of MCU, children were divided into groups of non-VUR, low-grade and high-grade VUR.

RESULTSA total of 370 children (233 boys, 137 girls) were included, of whom 263 (71.1%) had abnormal DMSA results and 126 (34.1%) were identified as VUR on MCU. Among children with VUR, the number of high-grade was 103 (81.7%). The rate of abnormal results on DMSA of high-grade VUR group was significantly higher than the rates of the other two groups (P < 0.01). The sensitivity of DMSA for detecting high grade VUR was 99.0%. The negative predictive value was 99.1% and negative likelihood ratio was 0.03, respectively.

CONCLUSIONHigh-grade VUR remains an important risk factor of renal damage for young children with febrile UTI. The possibility to detect high-grade VUR on MCU is rather low when the result of DMSA is negative. It is recommended that DMSA be used before MCU to investigate the febrile UTI children at acute phase, because it would predict the majority of children with high-grade VUR while detecting renal lesions.