Initial presentation of scintigraphic changes during the first episode of acute pyelonephritis in children

Abstract

99mTc-DMSA scintigraphy is generally accepted as the method of choice for detecting renal parenchymal damage in pyelonephritis. 99mTc-MAG3 dynamic scintigraphy is not routinely used for this purpose. The AIM of this study was to evaluate the MAG3 scintigraphic presentation in the acute phase of pyelonephritis in children and re-evaluate them at least 6 months later, as well as to establish whether a MAG3 in the parenchymal phase is as reliable and sensitive in the detection of a renal parenchymal damage as the DMSA. The MAG3 scintigraphic pattern was evaluated during the first episode of acute pyelonephritis in 31 children (median age: 2.5 years) and compared to the DMSA scan. The scintigraphy was performed on the same day with both radiopharmaceuticals. After at least 6 months the whole procedure was repeated on 28 patients. A scoring system was designed to evaluate the parenchymal lesions, and categorize them as positive or equivocal. The findings on the initial scans were compared to those obtained in the follow up studies. When all lesions (equivocal + positive) were analysed, MAG3 sensitivity was 98%, and specificity 78%, while for positive lesions only, the values were 83 and 100%, respectively. The average acute severity score was significantly lower for both MAG3 and DMSA then the follow up score (p < 0.0001). These results corresponded to a clinical convalescence, which was observed in 26/28 children in the follow up. With the MAG3 scintigraphy a reliable semi quantitative and qualitative detection of the renal inflammatory lesions can be obtained in acute pyelonephritis, as well as their recovery, thus obviating the need for a DMSA scan. Moreover, the duration of the MAG3 procedure is shorter, enabling the visualization of the entire collecting system as well, while the radiation exposure is approximately a half of that delivered by the DMSA scan.