Cortical Scintigraphy Research Articles

Clinical guideline for static renal cortical scintigraphy in paediatrics.

Clinical guideline for static renal cortical scintigraphy in paediatrics.

Kronik Piyelonefritin Nadir Bir Nedeni: Ksantogranulomatöz Piyelonefrit

Xanthogranulomatous pyelonephritis (XGP) is a chronic, destructive, granulomatous inflammation of the renal parenchyma leading non-functioning kidney. Contrast-enhanced computed tomography is the most useful diagnostic method. A 6-year-old female patient admitted to us with complaints of abdominal pain, fever, fatigue, weakness. Recurrent urinary tract infection was present in her history. The patient’s urine specimen revealed leukocyturia, hematuria, positive for nitrite and bacteria, white blood cell: 12.7x103 /microl, hemoglobin:6.2 g/dl and CRP: 101 mg/dl. In the urinary system USG imaging, the contours of the left kidney were irregular and lobulated, and medullary punctate echogenicity and calcifications were present. Contrast-enhanced abdominal computed tomography showed increased left kidney size and opacities suggestive of stone in the collecting system; pararenal area was heterogeneous. Although the patient's gentamicin treatment was completed in 7 days and meropenem treatment in 14 days, acute phase reactants did not regress. No activity uptake was observed in the left kidney lodge in renal cortical scintigraphy. Left total nephrectomy was performed with the diagnosis of non-functioning left kidney and chronic pyelonephritis. Kidney biopsy material were reported as XGP. XGP is a rare and aggressive cause of chronic pyelonephritis with serious consequences such as nephrectomy requirement.

Comparison of shear wave elastography and dimercaptosuccinic acid renal cortical scintigraphy in pediatric patients.

Although it causes low-dose radiation exposure, dimercaptosuccinic acid (DMSA) renal cortical scintigraphy is the gold standard examination method in the noninvasive diagnosis of renal scar tissue (RST). Shear wave elastography (SWE) has recently come to the fore as a technique for measuring kidney stiffness in the examination of RST. The present study aims to compare DMSA and SWE tests to evaluate whether SWE can be used instead of DMSA as a test that does not cause radiation exposure in pediatric patients. In this prospective study, sonographic elastography was performed on pediatric patients with DMSA images. In the SWE examination, measurements were made from each kidney's upper, middle and lower parts. DMSA and elastography data were compared for the diagnosis of RST. A total of 64 patients were included in the present study. There were 68.8% female ( n = 44) and 31.2% ( n = 20) male patients. There were 45 pediatric patients [Female 30 (66.7%), male 15 (33.3%)] in group 1 (pathological group) and 19 pediatric patients [Female 14 (73.7%), male 5 (26.3%)] in the control group. When DMSA data and SWE values were compared, it was found that elastography did not show a statistically significant performance in predicting renal scarring. In the existing literature, various studies reported different values for the diagnosis of renal stiffness using SWE. Similar to some previous studies, the present study observed no significant correlations between DMSA and SWE. Thus, DMSA preserves its major role and effectiveness as an important predictor of RST in pediatric patients.

Comparación entre el efecto de la nefrolitotomía percutánea miniaturizada vs. convencional en la función renal evaluada mediante gammagrafía renal con DMSA

Introduction and ObjectivesWe aimed to present a clinical study that compares standard and miniaturized percutaneous nephrolithotomy (PNL) effects on kidney function with scintigraphic imaging in primary kidney stone patients. Materials and MethodsOne hundred four patients were included in this prospective study between May 2014 and February 2017. Eligible patients were divided into two groups miniaturized PNL (mPNL) and standard PNL (sPNL) with matched-pair analysis (1:1 scenario). Technetium-99m Dimercaptosuccinic Acid cortical scintigraphy imaging was performed before and after the operation. ResultsThere were no differences between the two groups in terms of success rate (mPNL(63.5%) vs. sPNL(71.2%), p=0.403), serum creatinine, glomerular filtration rate, split renal functions pre- and postoperatively (p≥0.05). There was no relationship between the type of operation and new scar formation (p=0.780). The rates of serious complication (grades 3 and 4 according to modified Clavien-Dindo Classification) were higher in sPNL (p=0.034). Stone burden, duration of operation, hemoglobin drop, multiple access, blood transfusion, and angioembolization were higher in patients with scarred kidneys (p<0.001, p=0.008, p=0.004, p<0.001, p=0.003, p=0.001, respectively). In multivariate analysis, only multiple access was found statistically significant for predicting new scar formation (p<0.001, OR:24.28). ConclusionsMiniaturized and standard PNL are reliable and successful operations for treating large kidney stones. No significant difference was found between the operation types regarding a decrease in renal function.

Value of Cortical Scintigraphy with Technetium-99m Dimercaptosuccinic Acid (99mtc Dmsa) in Children with Acute Urinary Tract Infections

Value of Cortical Scintigraphy with Technetium-99m Dimercaptosuccinic Acid (99mtc Dmsa) in Children with Acute Urinary Tract Infections

Comparison of the effect of miniaturized and standard percutaneous nephrolithotomy on renal function assessed with DMSA scintigraphy

Introduction and objectivesWe aimed to present a clinical study that compares standard and miniaturized percutaneous nephrolithotomy (PNL) effects on kidney function with scintigraphic imaging in primary kidney stone patients. Materials and methodsOne hundred four patients were included in this prospective study between May 2014 and February 2017. Eligible patients were divided into two groups miniaturized PNL (mPNL) and standard PNL (sPNL) with matched-pair analysis (1:1 scenario). Technetium-99m Dimercaptosuccinic Acid cortical scintigraphy imaging was performed before and after the operation. ResultsThere were no differences between the two groups in terms of success rate (mPNL (63.5%) vs. sPNL (71.2%), p=0.403), serum creatinine, glomerular filtration rate, split renal functions pre- and postoperatively (p≥0.05). There was no relationship between the type of operation and new scar formation (p=0.780). The rates of serious complication (grades 3 and 4 according to modified Clavien–Dindo Classification) were higher in sPNL (p=0.034). Stone burden, duration of operation, hemoglobin drop, multiple access, blood transfusion, and angioembolization were higher in patients with scarred kidneys (p<0.001, p=0.008, p=0.004, p<0.001, p=0.003, p=0.001, respectively). In multivariate analysis, only multiple access was found statistically significant for predicting new scar formation (p<0.001, OR: 24.28). ConclusionsMiniaturized and standard PNL are reliable and successful operations for treating large kidney stones. No significant difference was found between the operation types regarding a decrease in renal function.

The comparison of radiation attenuation correction techniques for relative renal function in renal cortical scintigraphy

The comparison of radiation attenuation correction techniques for relative renal function in renal cortical scintigraphy

Comparison of Renal Ultrasonography and Technetium 99-M Dimercaptosuccinic acid Renal Cortical Scintigraphy in Identifying Renal Parenchymal Defects in Febrile Urinary Tract Infection In Children Less than Five Years Age

Comparison of Renal Ultrasonography and Technetium 99-M Dimercaptosuccinic acid Renal Cortical Scintigraphy in Identifying Renal Parenchymal Defects in Febrile Urinary Tract Infection In Children Less than Five Years Age

Urinary carbohydrate antigen 19-9 level as a biomarker in children with acute pyelonephritis.

Early and prompt diagnosis of pyelonephritis is of great importance in children. The aim of this study is to evaluate the diagnostic accuracy of urinary carbohydrate antigen 19-9 (CA19-9) levels for predicting acute pyelonephritis (APN) in children with urinary tract infection (UTI). Patients were allocated into two groups of APN and acute cystitis according to their diagnosis. Urine samples of all patients were collected. Also, complete history was taken, and physical examination, kidney and bladder ultrasonography, 99mTc-dimercaptosuccinic acid renal cortical scintigraphy, and urine analysis and culture were performed. Urinary CA19-9 was measured by an electrochemiluminescence enzyme immunometric kit. In addition, CA19-9 levels were measured in the APN group 2weeks and 3months later. A total of 100 children were included in this study (mean age 46 ± 31months, 16 males and 84 females). CA19-9 levels were significantly greater in the APN group than acute cystitis group (510 ± 328 vs. 18.7 ± 18.6 U/ml, P < 0.001). During follow-up periods of the APN group, CA19-9 levels decreased to 180 ± 124 U/ml after 2weeks (P < 0.001) and 30 ± 23 U/ml after 3months (P < 0.001). Urinary CA-19-9 had 95.3% sensitivity and 80% specificity for the diagnosis of APN. The area under the curve value of CA19-9 was 0.904 (95% CI 0.831-0.977).Conclusion: Urinary CA19-9 level can be used as a reliable biomarker for early detection of APN prior to urine culture confirmation in children with UTI. What is known: • Early and prompt diagnosis of pyelonephritis is necessary in children to prevent renal damage. • Acute pyelonephritis can present with vague and nonspecific symptoms in infants and children. What is new: • Urinary carbohydrate antigen 19-9 is a reliable biomarker for early detection of acute pyelonephritis prior to urine culture confirmation. • Urinary carbohydrate antigen 19-9 has 95.3% sensitivity and 80% specificity for diagnosis of acute pyelonephritis.

Hypertension, hypokalemia, and left adrenal tumor mimicking primary aldosteronism in a patient with 17α-hydroxylase deficiency

17α-hydroxylase deficiency (17OHD) is a rare disorder of secondary hypertension caused by congenital adrenal hyperplasia. In addition, co-occurrence of an adrenal tumor with 17OHD is extremely rare and easily misdiagnosed. A 33-year-old female with sicca syndrome, persistent hypertension, hypokalemia, and a left adrenal tumor was referred for confirmation of primary aldosteronism. However, the absence of secondary sexual characteristics, persistent growth beyond puberty, and laboratory data of low plasma renin activity, high aldosterone, low cortisol, low sex hormones, elevated adrenocorticotropic hormone, elevated luteinizing hormone, elevated follicle-stimulating hormone, and most importantly, decreased 17-hydroxypregnenolone, supported a diagnosis of 17OHD. We sequenced the CYP17A1 gene of the patient and her parents, which demonstrated genetic defects (D487-S,488-F489 deletion and Y329K418X). 17OHD was diagnosed. The left adrenal tumor was assessed, and a non-functional adrenal incidentaloma was confirmed; NP-59 adrenal cortical scintigraphy and adrenal venous sampling showed no functional activity and non-lateralization. Hormone replacements with estrogen, spironolactone, and prednisolone were given. The patient became more feminized and confident, and her hypertension was controlled. Early diagnosis and treatment of 17OHD not only can prevent delay development of secondary sexual characteristics but also help the patient maintain mental health and improve their quality of life. In addition, the concomitant presence of a left adrenal tumor makes misdiagnosis of a functional adenoma more likely, possibly causing unnecessary surgery and delay inappropriate treatment.

Dos and Don'ts that are Issued through Radiolabeling Process of DMSA (Dimercaptosuccinic Acid) by 99mTco4- as 99mTc-DMSA(III), the Gold Standard Radiopharmaceutical for Renal Cortical Scintigraphy

Objective: Since DMSA (Dimercaptosuccinic Acid) is an important and more sensitive kit in the realm of renal scintigraphy, in the course of this enormous study throughout five years, all quality control results from more than 500 Tc-99m radiolabeled DMSA kits and scans were studied to improve radiolabeling method through optimization of all involving parameters. Methods: Instant thin layer chromatography (ITLC) (support: ITLC-Silicic-acid (SA), solvent: n-Butanol Saturated with 0.3N HCl) were used to calculate %radiochemical purity (%Tc-99m DMSA). Data from ITLC and scans were investigated to obtain the optimized radiolabeling method so as to decrease background uptake particularly liver uptake. Results: Data suggested that if radiolabeling is performed under optimized involving parameters (Generator used day 2, SA=(15-20 mCi)/ (1cc) radiochemical purity=99.5% (Al2O3<5 ppm), generator’s pH=4-4.5), the % Tc-99m dimercaptosuccinic acid (DMSA) will be ≥ 90-95%. Moreover, more intricate scans with abnormal biodistribution of radiotracer developed the expanded view on99mTc-DMSA(III) renal scan impression with regard to diseases that can affect the99mTc-DMSA(III) biodistribution. During this investigation, it was concluded that almost all diseases that influence liver and spleen including fatty liver, mononucleosis and similar illnesses could change routine biodistribution of99mTc-DMSA(III). Conclusion: Finally, we suggested an optimized radiolabeling method99mTc-DMSA(III) ≥ 90-95%) to reach a precious imaging as more as we can decrease uncertainties about interpretation of Tc-99m DMSA scan considering patient’s background to provide an effective diagnosis.

Diagnostic Value of Technetium-99m-Dimercaptosuccinic Acid Scintigraphy in Prediction of Vesicoureteral Reflux in Children with First-time Febrile Urinary Tract Infection

Background: Imaging modalities such as voiding cystourethrography (VCUG), direct radionuclide cystography (DRNC), and renal cortical scintigraphy (RCS) with technetium-99m dimercaptosuccinic acid (Tc-99mDMSA), are helpful in detecting possible abnormalities of urinary tract such as vesicoureteral reflux (VUR). However, there are confounding data regarding the preference of these modalities. In the present study, we aimed to assess the role of Tc-99mDMSA scan in prediction of possible VUR and the subsequent need for VCUG or DRNC. Materials and Methods: Three hundred fifty seven children under 14 years old with first-time febrile urinary tract infection (UTI) who were admitted between April 2004 and February 2017 were enrolled. Data regarding to VCUG or DRNC in order to evaluate the presence of possible VUR were recorded. Finally, accuracy of Tc-99mDMSA scans in prediction of VUR were assessed. Results: Analyses showed a sensitivity and specificity of 95.65% and 14.72%, respectively for Tc-99mDMSA scan in detection of VUR. Patients with mild renal involvement in Tc-99mDMSA scans had a 3.5-fold greater risk of having VUR than those with a normal scans (odds ratio=3.5; 95% confidence interval [CI]: 1.4-8.58; p=0.007). In addition, the risk of VUR is up to 7.0-fold greater in children with moderate renal involvement (odds ratio=7.0; 95% CI: 2.6-13.2; p<0.0001) and up to 9.2-fold greater in children with severe renal involvement (odds ratio=9.2; 95% CI: 3.2-17.3; p=0.007) in the Tc-99mDMSA scans compared to those with a normal scans. Conclusion: According to the results, Tc-99mDMSA scan can be used as a screening test in prediction of VUR in infants and children with first- time febrile UTI.

Renal nuclear isotope study using dimercaptosuccinic acid in evaluating renal parenchymal changes in urinary tract infection in children

Background: Urinary tract infections (UTI) are among the most common diseases in childhood. The diagnosis and management of complicated UTI are difficult. The renal cortical scintigraphy using dimercaptosuccinic acid (DMSA) has been reported to be useful in children for confirmation of the diagnosis and for localization of parenchymal changes in acute pyelonephritis with renal scars. Objectives: To assess the role of 99m Tc-DMSA in identifying renal scars due to UTI in children. Materials and Methods: This study was a hospital-based prospective study conducted from November 2014 to October 2015. 53 children admitted with the first episode of the culture proven UTI. Children with vesicoureteric reflux or congenital renal anomalies were excluded from the study. All the patients were subjected to 99m Tc-DMSA. Results: An abnormal renal scan was observed in 28 out of 53 children (52.83%). The most common organism isolated was Escherichia coli (75.4%). All the children had fever (100%) followed by dysuria/increased frequency (50.94%). The majority of the renal parenchymal changes confined to the upper poles followed by lower poles and mid poles. Left kidney was involved more commonly (56%) than the right kidney (44%), whereas 3 children had bilateral involvement (10.71%). Parenchymal changes were common among children in 2-5 year age group (46.4%) followed by in children more than 5 years. Conclusion: DMSA renal scan has confirmed the high incidence of radiographically demonstrable renal scars in a significant number of children. It has helped to define parenchymal involvement in the form of pyelonephritic scars, the most common complication of UTI which is preventable.

Characterizing renal abnormalities in children with high anorectal malformation with renal scintigraphy: A single-centre experience

Objective: The purpose of this study was to characterize the renal abnormalities with renal scintigraphy in patients with high anorectal malformation (HARM). Patients and Methods: We retrospectively reviewed 53 patients who had undergone corrective surgery for HARM from July 2011 to January 2017 and who were referred to this department for Technetium-99m dimercaptosuccinic acid (Tc99m-DMSA) scan for evaluation of renal cortical scarring. Scintigraphic evaluation of all 53 patients included both dynamic renography [Tc-99m diethylene triamine penta acetic acid (DTPA) and Tc-99m-L, L-ethylenedicysteine (L-EC) scan] and cortical scintigraphy. A total of 68 scans were done in these 53 patients in which there were 38 Tc-99m DMSA scans, 15 Tc-99m DTPA and 15 Tc-99m EC scans. Tc-99m DTPA scans were done in 15 patients (26 kidneys) to look for glomerular filtration rate and drainage pattern. Results: Mean age of presentation of these 53 patients (86 kidneys or renal units) with HARM was 28.9 months. Out of 53 patients, male comprised 62.26% of cases (n = 33) and female comprised 37.7% of cases (n = 20). Spectrum of urologic abnormalities noted in our patients with HARM included unilaterally non-visualized kidney in 37.7% cases, i.e., 20/53 patients; hydroureteronephrosis in 28.3% of cases, i.e., 15/53 patients; hydronephrosis in 16.98% cases, i.e., 9/53 patients. Scarring was noted in 28.3% cases, i.e., 15/53 patients. Small kidney was noted in 10 patients out of 53, i.e., 18.8% of cases. Ectopic kidney was seen in 5.6% cases, i.e., 3/53 patients, horseshoe kidney in 3.7% (2/53) and duplex kidney was found in 1 patient, i.e., 1.8% of cases. Conclusion: Children with HARM have a high incidence of renal anomalies and these are the most common cause of morbidity and mortality in these patients. It is important to document these renal anomalies early in life and initiate management as early as possible. Apart from routine investigations, such as ultrasound, renal scintigraphy performed with Tc-99m DTPA, Tc-99m EC and Tc-99m DMSA-III are non-invasive investigations that may provide important help in diagnosis, follow-up and management of renal anomalies in these patients.

Interobserver Variability in Interpretation of Planar and SPECT Tc-99m-DMSA Renal Scintigraphy in Children.

Objective:This study objective was to evaluate interobserver agreement between individual pairs of three nuclear medicine physicians in interpretation of renal cortical scintigraphy in children with respect to the mode of acquisition (planar vs. SPECT), diagnoses and kidney site (left vs. right).Materials and Methods:Thirty children were imaged in planar and SPECT mode per protocol upon the injection of Tc-99m DMSA dose adjusted to their body weight. Patients were classified according to diagnoses into four groups. Three nuclear medicine physicians interpreted the findings blindly and independently. Renal defects were interpreted as focal and diffuse, per three renal segments. For the raters we calculated simple percentage agreement, the Cohen kappa statistic with 95% confidence intervals, and the overall kappa defining the levels of reliability as almost perfect or perfect, substantial, moderate, fair and slight agreement.Results:Interobserver agreement in planar interpretation was 77,2% (kappa=0.59; 95% confidence interval, 0.41 to 0.75) and SPECT 72,9% (kappa= 0,57; 95% confidence interval, 0,41 to 0,72). In planar interpretation, all individual pairs had moderate agreements except one that had a substantial agreement. In SPECT, all the pairs had moderate agreements except one that had an almost perfect agreement. Overall agreement per kidney site was on planar 73,4% for the left (kappa=0,54, moderate agreement), and 81,1% for the right kidney (kappa 0,63, substantial agreement). On SPECT, there was 72,2% agreement for the left (kappa=0,59, mode rate agreement), and 73,7% for the right kidney (kappa=0,54, moderate agreement). Overall agreement per diagnoses ranged from 70-88,9% on planar (kappa= -0,04 to 0,79), and 50-100% on SPECT (kappa=-0,02-1,000) indicating agreements from slight to substantial.Discussion:Our results suggest acceptable levels of interobserver agreement in all individual pairs of raters with respect to the mode of acquisition (planar vs. SPECT), diagnoses and kidney site (left vs. right). For the mode of acquisition, we would recommend hybrid imaging SPECT/CT method to be used whenever possible in the detection of renal cortical defects on Tc-99m-DMSA scintigraphy.

Urological and intestinal functional outcomes of sacrococcygeal teratoma following surgery

Surgery for sacrococcygeal teratoma (SCT) in neonatal period may result in functional problems of micturation and defecation caused by pelvic nerve dam - age. We aimed to evaluate long term outcome of patients with SCT in terms of bladder dynamics. To evaluate the postoperative urological outcome related with SCT excision, urodynamic study, ultrasonographic and scintigraphic ex - aminations were performed. The families are asked about the micturition and defecation paterns. Twenty-one patients (eight male, thirteen female) underwent SCT excision between 2006 and 2013 and seventeen (six male, eleven female) are regarded eligible for long term evaluation. Incidence of constipation was 9.4%, encopresis 9.4% and urinary incontinence 4.7%. Two patients had a his - tory of urinary tract infection without reflux on voiding cystourethrography or renal scarring on renal cortical scintigraphy. Three patients had increased post - voiding residual urine of 25 to 35 mL while four had increased bladder capacity. Meticulous surgical technique for excision of SCT in newborns may avoid sig - nificant urinary and defecation problems subsequently.

Role of renal cortical scintigraphy with Tc99m-DMSA in diagnosing renal scarring in patients undergoing staged reconstruction of classical urinary bladder exstrophy

Objectives: The purpose of this study was to find out incidence of renal cortical scintigraphy done with Technetium-99m (Tc-99m) dimercaptosuccinic acid III (DMSA-III), scan to diagnose cortical scarring in patients undergoing staged reconstruction of exstrophy bladder. Patients and Methods: We retrospectively reviewed 29 post operative patients who were referred to our department for Tc99m-DMSA scan to look for renal cortical scarring from January 2012 to April 2016. Tc-99m DMSA(III) scan was done in all 29 patients (58 kidneys). Tc-99m DTPA and Tc-99m L, L-EC scans were done in 9 (18 kidneys) and 2 (4 kidneys) patients respectively. Results: Out of 29 patients male comprised 69% of cases (n = 20) and female comprised 31% of cases (n = 09).The mean age of the presentation of patients with exstrophy bladder was 7.8 years. Tc-99m DMSA(III) scan was done in 29 patients (58 kidneys).Scarring was noted in 28/58 kidneys (48.27%) on Tc-99m DMSA(III) scan. Tc-99m DTPA scan was done in 9 patients (18 kidneys). In Tc-99m DTPA scan mean GFR (standardized Gates gamma camera method) was 71.91ml/min. Micturating cystouretherography(MCU) was done in 10 patients which revealed vesicoureteric reflux(VUR) in all the patients. DRCG was done in 1 patient which showed unilateral high grade VUR. Ultrasonography (USG) was done in 29 patients. Eighteen patients were found to have normal USG findings. Four patients had bilateral hydroureteronephrosis (HDUN) and one had unilateral HDUN. Three had mild hydronephrosis (HDN) and 3 had gross HDN. Conclusion: Preservation of renal function is one of the major goals of staged reconstruction of bladder exstrophy. Renal cortical scintigraphy with Tc-99m DMSA-III has become the “the gold standard” for renal cortical scarring imaging. Hence Tc-99m DMSA scan offers a significant diagnostic advantage over other diagnostic modalities to diagnose and follow up renal cortical scarring in patients with exstrophy bladder thus help in management.

The role of tissue harmonic imaging ultrasound combined with power Doppler ultrasound in the diagnosis of childhood febrile urinary tract infections.

This study assessed the ability of tissue harmonic imaging ultrasound combined with power Doppler ultrasound in the detection of childhood febrile urinary tract infections in comparison with the gold standard reference method: Tc-99m dimercaptosuccinicacid renal cortical scintigraphy. This prospective study included 60 patients who were hospitalized with a first episode of febrile urinary tract infections. All children were examined with dimercaptosuccinicacid scan and tissue harmonic imaging ultrasound combined with power Doppler ultrasound within the first 3 days of admission. Signs indicative of acute infection were observed in 29 patients according to the results of tissue harmonic imaging ultrasound combined with power Doppler ultrasound while dimercaptosuccinicacid scan revealed abnormal findings in 33 patients. The sensitivity, specificity, positive predictive value and negative predictive value of tissue harmonic imaging combined with power Doppler ultrasound using dimercaptosuccinicacid scintigraphy as the reference method in patients diagnosed with first episode febrile urinary tract infections were calculated as 57.58% (95% confidence interval: 40.81%-72.76%); 62.96% (95% confidence interval: 44.23%-78.47%); 65.52% (95% confidence interval: 52.04%-77%); 54.84% (95% confidence interval: 41.54%-67.52%); respectively. Although current results exhibit inadequate success of power Doppler ultrasound, this practical and radiation-free method may soon be comprise a part of the routine ultrasonographic evaluation of febrile urinary tract infections of childhood if patients are evaluated early and under appropriate sedation.

Technetium-99m dimercaptosuccinic acid scan in evaluation of renal cortical scarring: Is it mandatory to do single photon emission computerized tomography?

Objectives:Renal cortical scintigraphy with technetium-99m (Tc-99m) dimercaptosuccinic acid (DMSA) is the method of choice to detect acute pyelonephritis and cortical scarring. Different acquisition methods have been used: Planar parallel-hole or pinhole collimation and single photon emission tomography (SPECT). This study compared planar parallel-hole cortical scintigraphy and dual-head SPECT for detection of cortical defects.Patients and Methods:We retrospectively reviewed 190 consecutive patients with 380 kidneys and 200 DMSA scans referred to rule out renal cortical scarring. The diagnoses were 52 vesicoureteric reflux, 61 recurrent urinary tract infection, 39 hydronephrosis, 20 renal impairment, and 18 hypertension. All patients were imaged 3 h after injection of Tc-99m DMSA with SPECT and planar imaging (posterior, anterior, left, and right posterior oblique views). For each patient, planar and SPECT images were evaluated at different sittings, in random order. Each kidney was divided into three cortical segments (upper, middle and lower) and was scored as normal or reduced uptake. The linear correlation coefficient for the number of abnormal segments detected between planner and SPECT techniques was calculated.Results:From 200 DMSA scans, 100 scans were positive for scar in SPECT images, from which only 95 scans were positive for scar in planner imaging. Out of the five mismatched scans, three scans were for patients with renal impairment and high background activity and two scans were for very small scars. No significant difference was seen in the average number of abnormal segments detected by planar versus SPECT imaging (P = 0.31). The average correlation coefficient between was high (r = 0.91 – 0.92).Conclusions:Tc-99m DMSA renal cortical scanning using SPECT offers no statistically significant diagnostic advantage over multiple views planar imaging for detection of cortical defect.

Short Term Prognostic Utility of Tc-99m DMSA Renal Imaging in Sepsis Induced Acute Renal Failure; Provisional Data

Background: Sound prognostic data in sepsis induced acute renal failure (SARF) are lacking especially on the short term outcome [STO] in the intensive care unit [ICU]. We addressed the use of Tc-99m DMSA [2,3-dimercaptosuccinicacid] renal cortical imaging as a prognostic tool in SARF. Methods: Forty patients with acute renal failure due to sepsis [age range 15-74 years; median 44.5] were subjected for full history taking complete physical examination, routine ICU monitoring, routine laboratory investigations, APACHE II [Acute Physiology and Chronic Health Evaluation] and SOFA [Sequential Organ Failure Assessment] together with Tc-99m DMSA cortical renal scintigraphy. Patients’ death in the ICU or discharge was considered as the end point of the study representing the so-called short term outcome [STO]. Results: 25% mortality rate [10/40] was found along the admission period in the ICU. All non-survivors were abnormal with DMSA imaging [NPV & PPV 100% & 66.7% respectively]. Abnormal DMSA cases showed significant positive associations with serum creatinine at admission [r = 0.5; P 0.02]; admission duration [r = 0.4; P 0.002]; APACHE II score [r = 0.5; P 0.004] and STO [r = 0.4; P 0.03]. Statistically significant difference was elicited between subjects with normal and abnormal DMSA regarding the same parameters. Conclusion: This preliminary data could raise Tc-99m DMSA renal imaging as a prognostic tool in SARF that could allow influential interference to prohibit dramatic outcomes as mortality.