PURPOSE: An inter-observer variability exists in the measurement of the renal length during ultrasonography, but dimercaptosuccinic acid (DMSA) scintigraphy allows greater objectivity. Thus, the aim of this study was to evaluate the discrepancy of the renal length measured using the two methods. MATERIALS AND METHODS: Between January 2003 and June 2005, 249 consecutive patients underwent DMSA scintigraphy and ultrasonography. Due to the exclusion of kidneys where a photon defect was observed during DMSA scintigraphy, the number of kidney enrolled in this study was 439. The renal length measurements in any plane were longest using ultrasonography. The renal lengths were measured using DMSA scintigraphy by assessing the maximum pixel length, which was then converted to centimeters. RESULTS: The mean renal lengths measured by DMSA scitigraphy and ultrasonography were 8.06+/-1.49 and 6.80+/-1.38cm, respectively. The mean difference in the renal length measured between the two methods was 1.26+/-0.84cm. The sonographic renal length was significantly shorter than that found via scintigraphy (Student's t-test, p<0.001). CONCLUSION: Our results were similar to those of previously reported studies, where the scintigraphic renal length exceeded that obtained sonographically. Due to the possibility of underestimating the renal length when using ultrasonography, clinicians must be cautious when following up pediatric patients using ultrasonography.
Humans ; Kidney ; Observer Variation ; Radionuclide Imaging* ; Succimer* ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography*

No abstract available.
Succimer* ; Thymoma*

PURPOSE: The accurate diagnosis of acute pyelonephritis(APN) using clinical and laboratory parameters is often difficult in children. The 99mTc-dimercaptosuccinic acid (DMSA) renal scan is utilized as a gold standard for renal involvement, and renal ultrasonography(RUS) and voiding cystourethrography(VCUG) are utilized to evaluate underlying urinary tract anomalies. In this study the radiological imaging in children of different age groups, with clinical APN, were retrospectively compared. MATERIALS AND METHODS: Between May 1994 and April 2002, 375 children presented with a febrile urinary tract infection(UTI), and had a DMSA renal scan. Of the patients, 270 had RUS and 220 had contrast VCUG. The sensitivity of these tests in febrile UTI in three age groups was determined: group I less than 2 years; group II 2-5 years; group III older than 5 years. RESULTS: The clinical and laboratory manifestations of APN correlated better with a positive DMSA renal scan in the older children than in the younger children; 76.1% of the DMSA renal scans were positive in group III; 68.3% in group II; 50.8% in group I(p<0.05). RUS had no correlation with a positive DMSA renal scan in any of the age groups. Vesicoureteral reflux was more prevalent in the older age groups. High grades of reflux(grade IV-V) correlated better with positive DMSA renal scans(p<0.05). CONCLUSIONS: This study demonstrates that the clinical and laboratory manifestations of APN do not correlate with the findings of DMSA renal scans in young children. Therefore, a young child with a clinical suspicion of APN should be evaluated by a DMSA renal scan to confirm renal parenchymal involvement.
Child* ; Diagnosis ; Humans ; Pyelonephritis* ; Retrospective Studies ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography ; Urinary Tract ; Vesico-Ureteral Reflux

PURPOSE: The diagnosis of acute pyelonephritis (APN) is often difficult, as its clinical and biological manifestations are non-specific in children. If not treated quickly and adequately, however, APN may cause irreversible renal damage, possibly leading to hypertension and chronic renal failure. We were suspecting the diagnostic value of 99mTc-dimercaptosuccinic acid (DMSA) scan by experiences and so compared the results of DMSA scan to those of multi-detector row computed tomography (MDCT). METHODS: We retrospectively selected and analyzed 81 patients who were diagnosed as APN by MDCT during evaluation of their acute abdomen in emergency room and then received DMSA scan also for the diagnostic work-up of APN after admission. We evaluated the results of imaging studies and compared the diagnostic value of each method by age groups, <2 years (n=45) and > or =2 years (n=36). RESULTS: Among total 81 patients with MDCT-proven APN. DMSA scan was diagnostic only in 55 children (68%), while the remaining 26 children (32%) showed false negative normal findings. These 26 patients were predominantly male with average age of 21 months and most of them, 19 (73.1%) were <2 years of age. CONCLUSION: DMSA scan has obvious limitation compared to MDCT in depicting acute inflammatory lesions of kidney in children with APN, especially in early childhood less than 2 years of age. MDCT showed hidden lesions of APN, those were undetectable through DMSA scan in children.
Abdomen, Acute ; Child ; Emergencies ; Humans ; Hypertension ; Kidney ; Kidney Failure, Chronic ; Male ; Pyelonephritis ; Retrospective Studies ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid

PURPOSE: In the diagnosis of pediatric urinary tract infection(UTI), the use of invasive methods, such as voiding cystourethrography(VCUG), is controversial. A retrospective study was carried out to evaluate the necessity for VCUG in assessing pediatric UTI. MATERIALS AND METHODS: Between April 2000 and March 2002, 70 children (60 boys, 10 girls) with symptomatic UTI were evaluated. All patients were evaluated with renal ultrasonography(RUS), 99mTc-DMSA renal scintigraphy(DMSA renal scan) and VCUG. The results of the VCUG were compared with RUS and similar comparisons made between the results of the VCUG and DMSA renal scans. Patients with both normal a RUS and DMSA renal scan were then evaluated for the frequency and grade of vesicoureteral reflux(VUR) on the VCUG. RESULTS: The mean age at the initial evaluation was 7.95 months, ranging from 1 to 52 months. RUS and DMSA scan abnormalities were found in 38(54.3%) and 26(37.1%) children, respectively. Of the 22 patients with VUR confirmed by VCUG, 11(50.0%) had an abnormal RUS, and 12 (54.5%) patients had abnormal DMSA renal scans. Of the 19 patients with both a normal RUS and DMSA scan, 4(21.2%, 6 kidney-ureter unit) were found to have VUR on VCUG. CONCLUSIONS: This study illustrated that a considerable number of patients may have significant VUR, despite normal renal ultrasonography and DMSA scans. Therefore, VCUG remains important in assessing pediatric UTI.
Child* ; Diagnosis ; Humans ; Retrospective Studies ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid ; Ultrasonography ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

Evaluations of residual renal function and the therapeutic effectiveness in renal tuberculosis have largely been dependent on intravenous pyelogram or Contrast-CT scan, even though, exact renal function are not evaluated with there methads. 99mTc-DMSA is a radiopharmaceutical that is trapped in the functioning tubular cells of the kidney and therefore, quantitative renal function could be evaluoted by ineasuring the counts of renal radioactivity and concomittant evaluation of renal morphology could be passible with the analog imapes of the radioactivity. The authors retrospectively analyzed 99mTc-DMSA scans of 75 kidndys of 67 patients with confirmed renal tuberculosis. We classified the morphologies of tuberculous kidneys as 6 types. We classified the morphologies of tuberculous kidneys as 6 types such as the type with small cortical defect, with parenchymal ulcerocavernous lesions, ulcerocavernous fistula to pelvis, mass-like defects, contracted kidney with ureter visualization, and the type with nonvisualization of kidney, corresponding to the characters of renal tuberculous pathogenesis with abscess formation, ulcerocavernous fistula, and fibrosis, and correspondings to the renal anatomy with parenchyma, and pelvocalyceal collecting system. Their mean residual renal functions measured with 99mTc-DMSA uptake rates were 19.0%, 18.4%, 7.9%, 12%, 4.1%, 3.4% respectively.
Abscess ; Fibrosis ; Fistula ; Fluspirilene ; Humans ; Kidney ; Pelvis ; Radioactivity ; Retrospective Studies ; Succimer* ; Technetium Tc 99m Dimercaptosuccinic Acid ; Tuberculosis, Renal* ; Ureter

The vesicoureteral reflux (VUR) is frequently found among the patients with urinary tract infection (UIT) and some patients with VUR progress to reflux nephropathy. The presence of scarring at UIT is an important determinant in the selection of those at risk of progressive damage. 99m Technetium dimercaptosuccinic acid (99m Tc-DMSA) is a renal scanning agent provides a good quality of renal image as a result of preferential cortical accumulation. 99m Tc-DMSA scan and VCUG were performed in 133 patients diagnosed UTI at pediatric department of Kyung Hee University, College of Medicine from May, 1990 to May, 1992 The results were as follows: 1) VUR was seen in 27 children among 133 patients with UTI. The incidence was 20.3%. Under 1 year of age, male to female ratio was higher incidence of VUR. 2) Incidence of renal scarring was higher in patients with VUR than those of without VUR. 3) Grading of VUR in relation to age, the older the age, the lower the grade. 4) There is no correlation between renal scarring and grades of VUR. 5) In distribution of renal scarring, it was found to have tendency to develop at upper polar area, there was diffuse and multiple in patients with VUR. In conclusion the incidence of renal scarring was related to the age of onset, duration of UTI and the severity of the VUR and 99mTc-DMSA scan is mandatory in patient with UTI even without VUR in order to detect early phase of renal scarring.
Age of Onset ; Child ; Cicatrix* ; Female ; Humans ; Incidence ; Male ; Succimer ; Technetium ; Technetium Tc 99m Dimercaptosuccinic Acid ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

Ten children were selected out of 21 cases diagnosed as ureteropelvic junction obstruction between March, 1989 and March, 1992. The children were evaluated quantitatively using the renal cortical labeling agent, 99m technetium dimercaptosuccinic acid (Tc-DMSA), before and following pyeloplasty. The preoperative residual renal function and the extent of functional recovery were investigated. The children ranged from 15 months to 13 years old (average 6.8 years) and consisted of 8 boys and 2 girls. The obstruction was on the left in 7 cases and the right in 3. Symptoms on admission included pain in 5 cases, abdominal mass in 3 cases, and fever and chill in 2. The subjects divided into two groups. The first group consisted of children who did not have complications or other coexisting diseases, while the second consisted of who had pyonephrosis or vesicoureteral reflux. All patients underwent dismembered pyeloplasty and the results were satisfactory in all. 1. The preoperative differential renal function by Tc-DMSA renal scintigraphy ranged from 0.5% to 46.0% (mean 19.1%) and increased to 3.5% to 46.9% (mean 28.8%) postoperatively. 2. In five of the seven cases with uncomplicated ureteropelvic junction obstruction, differential renal function increased more than 1096 following pyeloplasty. In the two other cases which showed preserved renal function of up to 4096 preoperatively, noticeable changes not observed. 3. In the three cases with complicated ureteropelvic junction obstruction, (two cases associated with pyonephrosis and one case with vesicoureteral reflux) only slight increased differential renal function. In conclusion, we suggest that severely obstructed kidneys in infants and children spare nephrectomy and encourage pyeloplasty, even in cases of non-visualization on excretory urography in hopes of improving relative renal function.
Adolescent ; Child* ; Female ; Fever ; Hope ; Humans ; Infant ; Kidney* ; Nephrectomy ; Pyonephrosis ; Radionuclide Imaging ; Succimer ; Technetium ; Technetium Tc 99m Dimercaptosuccinic Acid* ; Urography ; Vesico-Ureteral Reflux

PURPOSE: For prevention of renal scar, early diagnosis and treatement of acute pyelonephritis are important in children with febrile urinary tract infection. But it has been difficult to differentiate acute pyelonephritis from lower urinary tract infection. We have performed this study to evaluate the diagnostic value of 99mTc-DMSA renal scan and to clarify the relationship among acute pyelonephritis, vesico-ureteral reflux and renal scar. METHODS: We have studied 100 patients with febrile urinary tract infection, from September, 1993 to June, 1995 at the Pediatric department of Ewha Womans University, Mok-dong hospital. Acute phase reactants, causative organism, renal ultrasound, 99mTc- DMSA renal scan on the acute stage, voiding cystouretherogram after 1-2 weeks of treatement, and follow-up 99mTc-DMSA renal scan were evaluated. RESULTS: Ther results are as follows; 1) 57 patients (57%) had defect on 99mTc-DMSA renal scan and diagnosed as acute pyelonephritis. 2) Acute phase reactants, renal ultrasound had low accuracy. 3) VUR was found in 31 (56.1%) of 57 patients with defect which was significantly higher than the 4 (9.3%) of 43 patients without defect on 99mTc-DMSA renal scan. 4) On the follow up 99mTc-DMSA renal scan, 34.8% of defects recorvered, and 65.2% of defects developed renal scar. CONCLUSIONS: 99mTc-DMSA renal scan is a valuable method for early diagnosis of acute pyelonephritis in children with febrile urinary tract infection. It would contribute to evaluate the relationship between acute pyelonephritis, vesico-ureteral reflux and renal scar.
Acute-Phase Proteins ; Child* ; Cicatrix ; Early Diagnosis* ; Female ; Follow-Up Studies ; Humans ; Pyelonephritis* ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid* ; Ultrasonography ; Urinary Tract Infections* ; Urinary Tract* ; Vesico-Ureteral Reflux

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.
Abdomen, Acute ; Blood Sedimentation ; C-Reactive Protein ; Child ; Fever ; Gamma Cameras ; Humans ; Infant ; Leukocytes ; Male ; Prevalence ; Pyelonephritis ; Succimer ; Technetium Tc 99m Dimercaptosuccinic Acid