Dimercaptosuccinic Acid Imaging Research Articles

1491 Hemi-Nephroureterectomy For Duplex Kidney in Children - The Resulting Effect on Renal Function

Abstract Introduction Urinary duplication systems occur in approximately 1% of the population, and may present with recurrent UTIs, incontinence, or be incidentally detected on imaging. DMSA (dimercaptosuccinic acid) imaging is used in these patients to assess split renal function. If found significantly reduced in a single moiety, children may be offered hemi-nephroureterectomy (HNU). We analysed the rate of remnant moiety loss following HNU comparing age and affected moiety. Method All HNUs performed at our paediatric tertiary centre 2005-2019 were analysed. Children <16yrs, with pre– and post-operative DMSA imaging were included. Renal loss was categorised as: significant (≥50% of pre-existing function), non-significant (≥25% pre-existing function), no renal loss (<25%), and complete loss (post-operative remnant moiety function ≤5%). Subgroup analysis was performed using χ² statistic. Results 73 patients were included, mean age 2.1yrs. Median pre-operative function of the affected kidney was 42%. 12 patients (16.4%) had significant renal loss, 13 (17.8%) non-significant loss and 6 (8.2%) had complete renal loss. Children <2yrs had significant and complete renal loss more frequently than those aged ≥2yrs (9/35 and 5/35 vs 3/38 and 1/38 respectively, p = 0.069). Patients with upper moiety HNU (UMHNU) had higher rates of significant and complete renal loss than lower moiety HNU patients (12/53=significant, 6/53=complete vs 0/20 significant/complete, p = <0.05). Conclusions HNU for duplex kidney is associated with high rates of remnant moiety damage, with ¼ of patients experiencing significant or complete renal loss. Subgroup analysis suggests this risk is higher in children <2yrs or UMHNU. HNU should therefore only be reserved for symptomatic patients failing conservative management.

Correlation between computed tomography volumetry and nuclear medicine split renal function in live kidney donation: a single-centre experience.

Potential live renal donors undergo both renal computed tomography angiogram (CTA) and nuclear imaging dimercaptosuccinic acid (DMSA) scans. Each kidney's renal function and vascular anatomy influences the choice of donor side. Although DMSA measures differential blood flow, it is a surrogate for renal function and nephron mass. Computed tomography techniques can provide volumetry information. The aim of this study was to determine the relationship between measured split renal volumes on computed tomography versus renal volumes derived from DMSA split function in live donors. Prospective data of live kidney donors assessed at a single Australian centre from 2014 to 2017 were reviewed. All patients had pre-operative CTA and DMSA imaging. Renal volume was determined via semi-automated software calculation from CTA three-dimensional image reconstructions by one investigator. Measured split renal volume was compared against calculated renal volume using measured DMSA split function (percentage split function multiplied by total renal volume). Fifty-three patients were included in the study. Split renal volumes on three-dimensional CTA images correlate to calculated split volumes determined from DMSA (Pearson coefficient 0.95 for right renal volume, 0.95 for left). The decision of which kidney to remove can be achieved with CTA only. Omitting a DMSA scan would reduce the radiation load by 0.70 mSv (35 chest X-rays) and potential cost saving of AU$1062.00 per donor. CTA technology allows accurate assessment of renal volumes that correlate well with DMSA split function. Avoiding a DMSA scan results in cost and radiation reduction in the assessment of a live kidney donor.

The examination of the nephroprotective effect of montelukast sodium and N-acetylcysteine ın renal ıschemia with dimercaptosuccinic acid imaging in a placebo-controlled rat model.

Purpose To determine the nephroprotective effect of NAC and Montelukast Sodium administration against the development of renal damage associated with long warm renal ischemia.Methods Twenty-seven rats were randomly divided into 3 study groups, which received NAC, montelukast and placebo, and 3 rats were included in the sham-treated control group. Medications were given 3 days before the procedure. DMSA renal scintigraphy was performed before and after surgery. The right renal pedicle was occluded for 45 min to induce ischemia and then subjected to reperfusion for 6 h (I/R groups).Results On pathological examination, the mean pathological scores of the montelukast and NAC groups were significantly lower than those of the placebo group. (p <0.05). In biochemical examination, significant differences were found in all parameter levels between the placebo group and the montelukast and NAC groups. (p <0.05) When postoperative DMSA renal scintigraphy measurements and renal function levels were compared, significant differences were found between the montelukast and NAC groups and the placebo and sham groups.Conclusion The administration of NAC and montelukast sodium was seen to have a nephroprotective effect against the development of renal damage associated with warm renal ischemia.

Clinical value of late DMSA scan in predicting Vesicoureteral Reflux in children with febrile Urinary Tract Infection

Aim: To assess the usefulness of late dimercaptosuccinic acid (DMSA) renal scans in revealing high-grade vesicoureteral reflux (VUR). Material and Methods: Between July 2015 and December 2016, medical records of 112 patients who were admitted with febrile urinary tract infections (fUTIs) were retrospectively reviewed. The demographic information of the patients, and follow-up imaging [ultrasonography (USG), DMSA renal scans, and voiding cystourethrography] data were reviewed.Results: Of the 112 patients, 82 patients (73.2%) were female, 30 were male (26.8%), and the mean age was 7.04 ± 3.94 years. Recurrent fUTIs were detected in 65 patients (58%). Of the patients, 68 (60.7%) had abnormal urinary system USG, and 74 (66.1%) had abnormal DMSA renal scans. Vesicoureteral reflux (VUR) was detected in 63 patients (56.3%). VUR was present in 49 (66.2%) of 74 patients with scarring in DMSA and detected in 14 (38.8%) of 38 patients with normal DMSA scans. Significant agreement (kappa: 0.274 / p=0.003) was found between DMSA and VUR results. The sensitivity, specificity and positive predictive values of late DMSA renal scan to predict VUR were 77.8 %, 49 % and 63.2% respectively.Conclusion: Abnormal late DMSA scans carry a higher sensitivity and positive predictive value for predicting high-grade VUR in children with recurrent fUTIs. Late DMSA imaging seems a useful option in screening for high-grade VUR in children when the acute interventions are limited.

Serum soluble ST2 as a marker of renal scar in pediatric upper urinary tract infection

Background and objectivesUpper urinary tract infection is the most common serious bacterial infection in childhood. Patients with upper urinary tract infection have a risk for renal scarring with subsequent complications including hypertension, proteinuria, and progressive renal failure. However, the predictive biomarkers of renal scarring in children with upper urinary tract infection are still unknown. In this study, we evaluated whether soluble ST2 levels can be biomarkers of subsequent renal scarring in patients with upper urinary tract infection. Design, setting, participants, and measurementsWe retrospectively studied pediatric patients with upper urinary tract infection at a tertiary center. Twenty-eight children had an upper urinary tract infection with (n = 14) and without (n = 14) renal scarring and underwent 99mtechnetium dimercaptosuccinic acid imaging. In addition, 13 control subjects were enrolled. The clinical data and serum cytokine levels, including soluble ST2 levels, were compared between those with and without renal scars. ResultsSerum soluble ST2 levels were significantly higher in the scar group than in the non-scar group, whereas there was no difference in the levels of serum interferon-γ, interleukin-6, interleukin-10, soluble tumor necrosis factor receptor 1, and transforming growth factor-β between the scar and non-scar groups. The area under the curve for differentiating between the non-scar and scar groups on the basis of measurements of serum soluble ST2 was 0.79, with a sensitivity and specificity of 92.9% and 64.3%, respectively. ConclusionThese results suggest that serum soluble ST2 levels on admission could be a useful biomarker of subsequent renal scarring in pediatric patients with upper urinary tract infection.

ANTENATALLY DIAGNOSED UPPER MOIETY HYDRONEPHROSIS IN A CHILD WITH ECTOPIC URETER: A CASE REPORT

An ectopic ureter is any ureter, single or duplex, that does not enter the trigonal area of the bladder. In a duplex system, the ectopic ureter is inevitably the upper pole ureter. In males, the ectopic ureter always enters the urogenital system above the external sphincter. The majority of ectopic ureters are detected through prenatal ultrasound imaging, even if the specific diagnosis is not made until after birth. Radionuclide renal imaging remains the gold standard for renal functional assessment, and this is usually best provided by dimercaptosuccinic acid imaging. The goals of therapy are the preservation of renal function; elimination of infection, obstruction, and reflux; and maintenance of urinary continence. We report a case of a 6-month-old male child presenting with urinary tract infection. The child was diagnosed to have had a cystic dilatation of the right upper moiety on antenatal ultrasonography imaging.

A single-center cohort of Canadian children with VUR reveals renal phenotypes important for genetic studies

Many genes and loci have been reported in genetic studies of primary vesicoureteral reflux (VUR), but few have been reproduced in independent cohorts, perhaps because of phenotype heterogeneity. We phenotyped children with VUR who attended urology clinics so we could establish criteria to stratify patients based on the presence or absence of a renal malformation. History, chart review, and DNA were obtained for 200 children with VUR from 189 families to determine the grade of VUR, the mode of presentation, and the family history for each child. Kidney length measured on ultrasound (US) and technetium dimercaptosuccinic acid (DMSA) scans at the time of VUR diagnosis were used to establish the presence of a concurrent renal malformation and identify the presence of renal scarring. There was an even distribution of girls and boys, and most patients were diagnosed following a urinary tract infection (UTI). Thirty-four percent of the children had severe VUR, and 25 % had undergone surgical correction. VUR is highly heritable, with 15 % of the families reporting multiple affected members. Most patients had normally formed kidneys as determined by US and DMSA imaging. Of the 93 patients who underwent DMSA imaging, 17 (18 %) showed scarring, 2 (2 %) showed scarring and diffuse reduction in uptake, and 13 (14 %) showed an isolated diffuse reduction in uptake. Prospective long-term studies of patients with primary VUR combined with renal phenotyping using US and DMSA imaging are needed to establish the presence of a renal malformation. The majority of patients in our study had no renal malformation. This cohort is a new resource for genetic studies of children with primary VUR.

Improvement in DMSA imaging using adaptive noise reduction

Dimercaptosuccinic acid imaging is the 'gold standard' for the detection of cortical defects and diagnosis of scarring of the kidneys. The Siemens planar processing package, which implements adaptive noise reduction using the Pixon algorithm, is designed to allow a reduction in image noise, enabling improved image quality and reduced acquisition time/injected activity. This study aimed to establish the level of improvement in image quality achievable using this algorithm. Images were acquired of a phantom simulating a single kidney with a range of defects of varying sizes, positions and contrasts. These images were processed using the Pixon processing software and shown to 12 observers (six experienced and six novices) who were asked to rate the images on a six-point scale depending on their confidence that a defect was present. The data were analysed using a receiver operating characteristic approach. Results showed that processed images significantly improved the performance of the experienced observers in terms of their sensitivity and specificity. Although novice observers showed significant increase in sensitivity when using the software, a significant decrease in specificity was also seen. This study concludes that the Pixon software can be used to improve the assessment of cortical defects in dimercaptosuccinic acid imaging by suitably trained observers.

Identifying Children with Vesicoureteral Reflux: A Comparison of 2 Approaches

Various screening approaches have been proposed to identify the subgroup of children with urinary tract infection who have vesicoureteral reflux. However, few studies have compared the sensitivity of screening approaches in a representative population of young children. We compared the sensitivities of the top-down ((99m)technetium dimercaptosuccinic acid renal scan to screen) and biomarker based (C-reactive protein level at presentation) approaches in identifying children with vesicoureteral reflux. We calculated the sensitivity of the 2 screening approaches in detecting vesicoureteral reflux and subsequently high grade (III or greater) vesicoureteral reflux in children. The top-down and C-reactive protein based approaches missed 33% and 29% of cases of high grade vesicoureteral reflux, respectively. The sensitivity of the top-down approach for detecting high grade vesicoureteral reflux was lower than previously reported. Further study of novel methods to identify children at risk for renal scarring is warranted.

Protective Locus Against Renal Scarring on Chromosome 11 in Affected Sib Pairs with Familial Vesicoureteral Reflux Identified by Single Nucleotide Polymorphism Linkage Analysis

We identified the loci associated with renal scarring risk and protection in affected sib pairs with familial vesicoureteral reflux. A genome-wide analysis of vesicoureteral reflux with high density single nucleotide polymorphisms was conducted in 43 families with 2 or more affected children. A total of 43 probands and 58 affected siblings were included in the analysis. Genomic DNA was extracted from blood or saliva from all patients. All nuclear families had complete parental genotypes and all were Caucasian. Renal scarring was present in 23 of the 43 probands as detected by dimercapto-succinic acid imaging. easyLINKAGE software was used for the genome-wide linkage analysis. A LOD (logarithm [base 10] of odds) score of 3.3 or greater was considered significant evidence of linkage and a LOD score of 2.4 or greater but less than 3.3 was considered suggestive evidence of linkage. Using the affected sib pair method of analysis, a statistically significant linkage peak with a multipoint LOD score of 3.66 for patients without renal scarring was identified on chromosome 11 at 47.97 cM. For the scarring group a peak with a multipoint LOD score of 2.69 was identified on chromosome 17, which provides suggestive evidence of linkage. Our results suggest that a locus on chromosome 11 is associated with protection against renal scarring in patients with vesicoureteral reflux. In addition, a new locus on chromosome 17 may be linked to renal scarring. Our results suggest that multiple genes contribute to the formation of the vesicoureteral reflux phenotype, with patients having a unique susceptibility to renal injury/damage.

Single Center Experience with Endoscopic Subureteral Dextranomer/Hyaluronic Acid Injection as First Line Treatment in 1,551 Children with Intermediate and High Grade Vesicoureteral Reflux

In recent years the endoscopic injection of dextranomer/hyaluronic acid has become an established alternative to long-term antibiotic prophylaxis and the surgical management of vesicoureteral reflux. We determined the safety and effectiveness of the endoscopic injection of dextranomer/hyaluronic acid as first line treatment for high grade vesicoureteral reflux. Between 2001 and 2010, 1,551 children (496 male, 1,055 female, median age 1.6 years) underwent endoscopic correction of intermediate and high grade vesicoureteral reflux using dextranomer/hyaluronic acid soon after the diagnosis of vesicoureteral reflux on initial voiding cystourethrogram. Vesicoureteral reflux was unilateral in 761 children and bilateral in 790. Renal scarring was detected in 369 (26.7%) of the 1,384 patients who underwent dimercapto-succinic acid imaging. Reflux grade in the 2,341 ureters was II in 98 (4.2%), III in 1,340 (57.3%), IV in 818 (34.9%) and V in 85 (3.6%). Followup ultrasound and voiding cystourethrogram were performed 3 months after the outpatient procedure, and renal ultrasound was performed annually thereafter. Patients were followed for 3 months to 10 years (median 5.6 years). Vesicoureteral reflux resolved after the first, second and third endoscopic injection of dextranomer/hyaluronic acid in 2,039 (87.1%), 264 (11.3%) and 38 (1.6%) ureters, respectively. Febrile urinary tract infections developed during followup in 69 (4.6%) patients. None of the patients in the series needed reimplantation of ureters or experienced any significant complications. Our results confirm the safety and efficacy of the endoscopic injection of dextranomer/hyaluronic acid in the eradication of high grade vesicoureteral reflux. We recommend this 15-minute outpatient procedure as the first line of treatment for high grade vesicoureteral reflux.

2192 DEVELOPMENT AND EVALUATION OF NEAR INFRARED FLUORESCENT IMAGING AS A SENSITIVE, NON-RADIATING ALTERNATIVE TO SCINTILLOGRAPHY FOR DIAGNOSIS OF PYELONEPHRITIS

You have accessJournal of UrologyImaging/Radiology: Uroradiology II1 Apr 20122192 DEVELOPMENT AND EVALUATION OF NEAR INFRARED FLUORESCENT IMAGING AS A SENSITIVE, NON-RADIATING ALTERNATIVE TO SCINTILLOGRAPHY FOR DIAGNOSIS OF PYELONEPHRITIS Brian M. Rosman, Joao A. Barbosa, S. Ted Trevis, Alan B. Retik, and Hiep T. Nguyen Brian M. RosmanBrian M. Rosman Boston, MA More articles by this author , Joao A. BarbosaJoao A. Barbosa Boston, MA More articles by this author , S. Ted TrevisS. Ted Trevis Boston, MA More articles by this author , Alan B. RetikAlan B. Retik Boston, MA More articles by this author , and Hiep T. NguyenHiep T. Nguyen Boston, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2366AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Imaging with Di-Mercaptosuccinic acid (DMSA) is the current radiographic standard for diagnosing pyelonephritis in children. This test necessitates the injection of a radioactive tracer agent and produces a low-resolution image that requires a high level of training and experience to properly interpret. Near infrared imaging is a modality that does not involve ionizing radiation and has the potential for being highly sensitive for diagnosing various urological conditions. Previous work has demonstrated that Prosense 750 FAST (Perkin Elmer), a near infrared fluorescent imaging agent that is specifically activated by inflammatory enzymes (Cathepsins), can be used to identify pyelonephritis in a swine model. The objective of this study is to determine and compare the sensitivity and specificity of Prosense imaging with that of DMSA and direct histologic evaluation. METHODS Human pathogenic E. coli was cultured in broth and mixed with swine blood. The resultant clot was injected under ultrasound guidance into the parenchyma of a swine kidney to simulate pyelonephritis. Two to five days later, the animal was anesthetized, and imaging with DMSA followed by Prosense 750 FAST was performed. The DMSA scan was interpreted by a pediatric nuclear medicine specialist. Histological evaluation was performed on the represented sections from the infected kidney. RESULTS Imaging with Prosense demonstrated higher sensitivity and specificity for areas of infection/inflammation than DMSA. Fluorescent areas observed in renal cortex on Prosense imaging correlated with histological findings of inflammatory cells, suggestive of an active infection. In contrast, these same areas of inflammation/infection were not detected on the DMSA scan. Only when the infection progressed and became extensive did it become evident on DMSA imaging. CONCLUSIONS Near infrared fluorescent imaging with Prosense 750 FAST is a sensitive and non-radiating alternative to DMSA for the detection of pyelonephritis. Its use may allow for early detection of renal infection and provides a mean of distinguishing between active and prior infection or dysplasia. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e884 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brian M. Rosman Boston, MA More articles by this author Joao A. Barbosa Boston, MA More articles by this author S. Ted Trevis Boston, MA More articles by this author Alan B. Retik Boston, MA More articles by this author Hiep T. Nguyen Boston, MA More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

5-Year Prospective Results of Dimercapto-Succinic Acid Imaging in Children With Febrile Urinary Tract Infection: Proof That the Top-Down Approach Works

5-Year Prospective Results of Dimercapto-Succinic Acid Imaging in Children With Febrile Urinary Tract Infection: Proof That the Top-Down Approach Works

5-Year Prospective Results of Dimercapto-Succinic Acid Imaging in Children With Febrile Urinary Tract Infection: Proof That the Top-Down Approach Works

Evaluation in children after febrile urinary tract infection involves voiding cystourethrogram, which emphasizes urinary reflux rather than renal risk. We believe that early dimercapto-succinic acid renal scan after febrile urinary tract infection predicts clinically significant reflux and which children should undergo voiding cystourethrogram. The criticism of this approach is that some reflux and preventable renal damage would be missed. This study validates the use of initial dimercapto-succinic scan and presents 5-year renal outcomes. We prospectively studied children with febrile urinary tract infection using initial dimercapto-succinic acid renal scan, voiding cystourethrogram and renal/bladder ultrasound. Children with anatomical or neurological genitourinary abnormality and protocol failures were excluded from analysis. Dimercapto-succinic acid scan was repeated at 6 months if initially abnormal. Followup was done every 6 months in all children for at least 5 years. A total of 121 children fit study inclusion criteria and completed the 5-year study. Overall 88 initial dimercapto-succinic acid scans (73%) were abnormal and 78 children (64%) had urinary reflux. The OR of having clinically significant reflux predicted by abnormal initial scan was 35.4. Abnormal followup scan did not predict clinically significant reflux. Overall subsequent urinary tract infection developed in 32 patients (26.5%) and 27 (85%) had an abnormal initial scan. No child with a normal initial scan had clinically significant reflux. Dimercapto-succinic acid scan can predict clinically significant reflux and children at greatest renal risk. Initial dimercapto-succinic acid scan should be done in all children after febrile urinary tract infection while voiding cystourethrogram should be reserved for those with an abnormal initial dimercapto-succinic acid scan.

The IL-6 −174G/C polymorphism and renal scarring in children with first acute pyelonephritis

Urinary tract infections (UTI) are common in infants and children and may result in serious complications, such as renal scarring, hypertension, and renal failure. Identification of the new markers in relation to acute pyelonephritis (APN) and its treatment is essential for designing interventions that would minimize tissue damage. This prospective study investigated the first UTI infection in 71 children (age range: 1-24 months) in respect to interleukin-6 (IL-6) -174G/C polymorphism and renal scarring. The patients were divided into an APN group and a lower UTI group according to dimercaptosuccinic acid (DMSA). The IL-6 -174G/C genotypes were determined by tetra-primer ARMSPCR. Serum IL-6 was significantly higher in the APN group than in the group with lower UTI (p<0.05). In both groups, the -174G/C genotype and allele frequencies did not differ significantly from the control group. The highest white blood cell (WBC) count was observed in the CC genotype (p<0.05). A non-significant trend toward higher serum IL-6 was observed in children with CC genotype. On follow-up DMSA imaging performed 6 months later, renal scarring was detected in 36.9% of APN children. We did not find the significant association of IL-6 -174G/C polymorphism with APN and/or postinfectious renal scarring. These results indicate that serum IL-6 concentrations were significantly higher in children with APN than in patients with lower UTI.

Importance of Methodology on 99mTechnetium Dimercapto-Succinic Acid Scintigraphic Image Quality: Imaging Pilot Study for RIVUR (Randomized Intervention for Children With Vesicoureteral Reflux) Multicenter Investigation

We reviewed our experience with (99m)technetium dimercapto-succinic acid scintigraphy obtained during an imaging pilot study for a multicenter investigation (Randomized Intervention for Children With Vesicoureteral Reflux) of the effectiveness of daily antimicrobial prophylaxis for preventing recurrent urinary tract infection and renal scarring. We analyzed imaging methodology and its relation to diagnostic image quality. (99m)Technetium dimercapto-succinic acid imaging guidelines were provided to participating sites. High-resolution planar imaging with parallel hole or pinhole collimation was required. Two core reviewers evaluated all submitted images. Analysis included appropriate views, presence or lack of patient motion, adequate magnification, sufficient counts and diagnostic image quality. Inter-reader agreement was evaluated. We evaluated 70, (99m)technetium dimercapto-succinic acid studies from 14 institutions. Variability was noted in methodology and image quality. Correlation (r value) between dose administered and patient age was 0.780. For parallel hole collimator imaging good correlation was noted between activity administered and counts (r = 0.800). For pinhole imaging the correlation was poor (r = 0.110). A total of 10 studies (17%) were rejected for quality issues of motion, kidney overlap, inadequate magnification, inadequate counts and poor quality images. The submitting institution was informed and provided with recommendations for improving quality, and resubmission of another study was required. Only 4 studies (6%) were judged differently by the 2 reviewers, and the differences were minor. Methodology and image quality for (99m)technetium dimercapto-succinic acid scintigraphy varied more than expected between institutions. The most common reason for poor image quality was inadequate count acquisition with insufficient attention to the tradeoff between administered dose, length of image acquisition, start time of imaging and resulting image quality. Inter-observer core reader agreement was high. The pilot study ensured good diagnostic quality standardized images for the Randomized Intervention for Children With Vesicoureteral Reflux investigation.

CESSATION OF PROPHYLACTIC ANTIBIOTICS FOR MANAGING PERSISTENT VESICOURETERAL REFLUX

We reviewed our experience with patients with vesicoureteral reflux treated off prophylactic antibiotics. We retrospectively reviewed the records of patients with vesicoureteral reflux treated off prophylactic antibiotics, noting the intervals on and off antibiotics, urinary tract infection, signs and symptoms associated with urinary tract infection, and renal ultrasound and dimercapto-succinic acid scan findings. We identified 196 patients with vesicoureteral reflux treated off prophylactic antibiotics, including 122 who were infection-free while on and 124 who had no urinary tract infection while off prophylactic antibiotics. The infection rate on and off prophylactics was 0.29 and 0.24 urinary tract infections per patient per year, respectively. New scars were identified in 5 patients while on prophylactics and in 7 after antibiotics were discontinued. Comparing different subgroups off prophylactic antibiotics showed that children who presented with scarring had statistically fewer new scars than those with normal initial dimercapto-succinic acid imaging (p <0.043). Girls had significantly more urinary tract infections than boys while off prophylactics (p <0.01) despite the older age at antibiotic cessation. However, after infection occurred while off prophylactic antibiotics, new renal scars developed at about the same rate in boys and girls. Because most patients did not have a urinary tract infection while off prophylactic antibiotics, new renal scars developed in only 2.2% of all boys and 4% of all girls. Our findings imply that discontinuing antibiotics is reasonable and safe in patients in whom vesicoureteral reflux fails to resolve.

THE DYSFUNCTIONAL VOIDING SCORING SYSTEM: QUANTITATIVE STANDARDIZATION OF DYSFUNCTIONAL VOIDING SYMPTOMS IN CHILDREN

THE DYSFUNCTIONAL VOIDING SCORING SYSTEM: QUANTITATIVE STANDARDIZATION OF DYSFUNCTIONAL VOIDING SYMPTOMS IN CHILDREN

Risk assessment of renal cortical scarring with urinary tract infection by clinical features and ultrasonography

AIMSTo address some of the issues in the ongoing debate over the optimal diagnostic imaging following childhood urinary tract infection (UTI), by determining the risk of missing renal cortical scarring...

Technetium-99m pentavalent dimercaptosuccinic acid imaging in patients with pituitary adenomas

We studied the tumor-seeking agent technetium-99m-labeled pentavalent dimercaptosuccinic acid ([99mTc](V)DMSA) to visualize 21 growth hormone (GH)-, nine prolactin (PRL)-, two mixed GH/PRL-, six adrenocorticotrophin (ACTH)-secreting and 15 clinically non-functioning pituitary adenomas, three craniopharyngiomas and one dysgerminoma of the sella. All non-adenomas and 31 out of 53 adenomas were studied before treatment: 22 after surgery and/or radiotherapy. Eight cases of acromegaly were studied before and after chronic treatment with octreotide, whereas three cases of acromegaly, one of prolactinoma and two of non-functioning adenoma were imaged before and after adenomectomy. As a control group, 27 patients without any clinical evidence of pituitary adenoma were studied: 10 of them were operated on previously and treated with iodine-131 for metastatic thyroid carcinoma, 10 had brain tumors and the remaining seven patients had functional pituitary hypersecretion (four Klinefelter's syndrome, two primary hypothyroidism and one Addison's disease). The scintigraphy was repeated after testosterone in Klinefelter's syndrome, L-thyroxine in primary hypothyroidism and cortisone administration in Addison's disease. Seventeen GH-secreting (81%), seven PRL-secreting (78%), three ACTH-secreting (50%), 15 non-functioning (100%) and one (50%) mixed adenoma significantly concentrated [99mTc](V)DMSA, showing elevated tumor-to-background (T/B) ratios. The T/B ratios were similar in untreated and surgically treated adenomas (11.2 +/- 5.6 vs 11.8 +/- 6.2). Radiotherapy significantly lowered the [99mTc](V)DMSA uptake to 5.1 +/- 2.8 (p < 0.1 vs untreated patients). Non-adenomatous lesions of the sella turcica did not concentrate [99mTc](V)DMSA in the pituitary as well as brain tumors and 8 out of 10 metastatic thyroid cancers. The treatment with octreotide normalized GH and insulin-like growth factor I levels and reduced [99mTc](V)DMSA from 15.7 +/- 4.8 to 13.5 +/- 3.9 (p < 0.05). Conversely, adequate substitutive therapy completely inhibited the uptake of the radiotracer in Klinefelter's syndrome, in primary hypothyroidism and in Addison's disease. The [99mTc](V)DMSA scintigraphy showed an overall sensitivity of 81% (43/53) in detecting pituitary adenomas, which was increased to 95% for lesions greater than 10 mm in size. High-quality images with minimal total body radiation were obtained, enabling a good in vivo characterization of viable adenomatous tissue as well as an accurate monitoring of the effects of different therapeutic regimens.