DMSA Scintigraphy Research Articles

Determining Split Renal Function in Children With Ureteropelvic Junction Stenosis: Technetium-99m Mercaptoacetyltriglycine (Tc-99m MAG-3) or Technetium-99m Dimercaptosuccinic Acid (Tc-99m DMSA)?

Background Ureteropelvic junction stenosis (UPJS) is the most common cause of clinically significant antenatal hydronephrosis. We compared separate renal function results obtained using technetium-99m-mercaptoacetyltriglycine (Tc-99m MAG-3) and technetium-99m-dimercaptosuccinic acid (Tc-99m DMSA) in pediatric patients with UPJS to evaluate the adequacy of Tc-99m MAG-3 scintigraphy and the necessity of additional Tc-99m DMSA scintigraphy during follow-up. Methodology Patients diagnosed with hydronephrosis in the Pediatric Nephrology Department of Pamukkale University Faculty of Medicine over a period of 10 years (2012-2022) were evaluated retrospectively. Patients who had been diagnosed with UPJS and underwent both Tc-99m MAG-3 and Tc-99m DMSA scintigraphy during follow-up were included in the study. Technetium-99m-labeled MAG-3 and DMSA scans were re-evaluated for all patients by the Department of Nuclear Medicine. Results The study included 52 children with unilateral UPJS (12 girls and 40 boys) with a mean age of 6.34 ± 4.81 years (range: 2.97-9.79 years). Thirty-six patients (69.2%) were diagnosed antenatally. Differential renal function in Tc-99m DMSA was 46.94 ± 10.64 and in Tc-99m MAG-3 was 43.08 ± 11.18; the functions were lower in Tc-99m MAG-3, but the values were within normal limits for both groups (p=0.0001, z=-3.893). When differential renal functions were compared between Tc-99m DMSA and Tc-99m MAG-3 results, a statistically significant positive and strong correlation was found in the kidney with ureteropelvic junction obstruction (UPJO) (p=0.0001, r=0.752). When classifying the Tc-99m MAG-3 and Tc-99m DMSA results in the kidney with UPJO (supranormal, normal, low function) for the determination of differential renal functions, there was a consistency of 76%, and it was correlated (p=0.0001, k=0.456). While two patients had supranormal function and 13 patients had low function in Tc-99m MAG-3, five patients had supranormal function, and eight patients had low function in Tc-99m DMSA. Conclusions Some studies in the literature have reported that Tc-99m MAG-3 causes supranormal function measurements in patients with UPJS; our results showed that Tc-99m DMSA resulted in a higher rate of supranormal values for affected kidneys. We believe that Tc-99m DMSA should not be performed in addition to Tc-99m MAG-3 scintigraphy in the follow-up of every patient with UPJS but can be utilized in select cases, such as patients with surgical indications and those suspected before surgery.

The effect of well-managed lower urinary tract dysfunction on the success rate of endoscopic subureteric injection for low-moderate vesicoureteral reflux.

We aimed to study the presence of lower urinary tract dysfunction (LUTD) and those objective parameters obtained from voiding diary (VD), uroflowmetric (UF) and postvoiding residual urine (PVR) and voiding dysfunction symptom score (VDSS) as possible factors effecting the success rate on STING to correct VUR. Children who underwent STING for the first time due to low-moderate (I-III) grade of VUR were evaluated retrospectively. All children diagnosed with VUR were routinely evaluated for LUTD with VD, UF, PVR and VDSS. Children with LUTD were treated with urotherapy and appropriate medical treatment. Each system with VUR was accepted a renal unit and divided into two groups according to the presence of postoperative VUR: Group 1 no VUR, and Group 2 unresolved VUR. Demographic characteristics, DMSA scintigraphy findings, PVR, VDSS and parameters of VD and UF were compared. 80 children (73 (91.3%) girl, 7 (8.8%) boy) with a total of 112 unit were detected. There were 93 (83%) units in group 1 and 19 (17%) in group 2. No difference was observed in voiding frequency and urinary incontinence in VD, flow pattern, maximum flow rate, MBC/EBC maximum bladder capacity/expected bladder capacity in UF, PVR and VDSS between two groups. 21 (26.25%) children were diagnosed and treated for LUTD and STING was successful in 21 (84%) of 25 units. We believe that effectively treated preoperative LUTD provides comparable STING success rate for correcting low- to moderate-grade vesicoureteral reflux (VUR) in the short term.

The association of urinary BDNF, ATP, and MMP-2 with bladder compliance in children with myelodysplasia.

The purpose of our study was to evaluate the relationship of urinary brain-derived neurotrophic factor (BDNF),adenosine triphosphate (ATP),matrix metallopreteinase-2 (MMP-2) with urodynamic findings and upper urinary tract deterioration (UUTD) in children with myelodysplasia. Children with myelodysplasia evaluated in outpatient clinic between 2022 and 2023 were included. All patients underwent urinary ultrasonography, voiding cystourethrography, urodynamics, and DMSA scintigraphy. Urine samples were collected before urodynamics. Control urine was collected from 10 healthy children. Urinary biomarker values of patients and controls were compared, and subgroup analysis was performed. The median age of 40 children (26 girls) included in the study was 108 (8-216) months, and the control group (sixgirls) was 120 (60-154) (p = 0.981). Urinary BDNF, MMP-2, and ATP were found to be significantly higher in children with myelodysplasia compared to the control (p = 0.007, p = 0.027, p = 0.014, respectively). The three biomarker values were similar in children with bladder compliance below or above 10 cmH2O/mL(p = 0.750, p = 0.844, p = 0.575). No difference was found in terms of UUTD in all three biomarkers (p = 0.387, p = 0.892, p = 0.705). A negative correlation was found between urinary ATP and compliance (p < 0.05). In this study, all three biomarkers were found to be higher in children with myelodysplasia than in controls. There was a negative correlation between urinary ATP and compliance. Urinary biomarkers may contribute the follow-up of children with neurogenic lowerurinary tract deterioration in future with their noninvasive features. However, the lack of standardization and the inability to reliably predict risky groups are important shortcomings of urinary biomarkers.

Exstrophy-epispadias complex: are the kidneys and kidney function spared?

Exstrophy-epispadias complex (EEC) is a complex malformation of the lower abdominal wall, bladder, and pelvic floor, which necessitates multiple successive reconstruction procedures. Surgical and infectious complications are frequent. Our aim was to evaluate kidney function in these patients. This cross-sectional study included patients with EEC, followed since birth in a pediatric urology clinic, who underwent nephrological evaluation (blood pressure (BP) measurement and blood and urine chemistries) and imaging studies (urinary tract ultrasound and DMSA kidney scan) during 2017-2020. Forty-three patients (29 males), median age 9years (interquartile range 6-19), were included. Eleven (26%) used clean intermittent catheterization (CIC) for bladder drainage. At least one sign of kidney injury was identified in 32 (74%) patients; elevated BP, decreased kidney function (estimated glomerular filtration rate (eGFR) < 90ml/min/1.73m2), and proteinuria/albuminuria were detected in 29%, 12%, and 36% of patients, respectively. Urinary tract dilatation (UTD) was found in 13 (37%) ultrasound examinations. Parenchymal kidney defects were suspected in 46% and 61% of ultrasound and DMSA scintigraphy, respectively. UTD was significantly associated with DMSA-proven kidney defects (p = 0.043) and with elevated BP, 39% vs. 20% in those without UTD. Decreased eGFR and elevated BP were less frequent among patients on CIC than among patients who voided spontaneously: 10% vs. 14% and 18% vs. 36%, respectively. Recurrent UTIs/bacteriuria and nephro/cystolithiasis were reported by 44% and 29% patients, respectively. The high rate of signs of kidney injury in pediatric patients with EEC dictates early-onset long-term kidney function monitoring by joint pediatric urological and nephrological teams. A higher resolution version of the Graphical abstract is available as Supplementary information.

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.

Nephro-urological outcomes of a proactive management of children with spina bifida in their first 5 Years of life

The proactive management of spina bifida (SB), especially of its severe form, myelomeningocele (MMC), has contributed to decreasing chronic kidney disease (CKD). The objective of this study is to present the evolution of 5-year-old patient with MMC followed from birth with a proactive approach. This retrospective study included 55 cases with MMC of up to 5 years of age. All of them were admitted at birth and followed by a multidisciplinary group, with a proactive approach: CIC and anticholinergics. In the same group, the variables were compared within the first year and the within the fifth year of life. Chronic kidney disease (CKD) was defined by: alterations on renal DMSA scintigraphy; alterations in microalbuminuria/creatininuria ratio, proteinuria 24 hs and decrease in glomerular filtration rate (GFR) calculated with Schwartz bedside equation. Although overactivity, UTI and VUR decreased throughout the first 5 years (49, 9 and 12%), reduced cystometric capacity, DLPP >40 cm of water and end-filling pressure (Pdet) >20 cm of water increased (41, 27 and 61%). All patients at 5 years of age required CIC. Reduced cystometric capacity and VUR were more significant with abnormal DMSA (36%) at 5 years old ( p: 0.03). Proteinuria and CKD increased to 25% and 49%. Similarly, the need for enalapril increased from 10% to 27%. The microalbuminuria/creatininuria ratio was pathological in 27.3%. 48 patients (87%) remained unchanged on DMSA scan and the other 7 underwent modifications (4 new cases with altered DMSA) over time. Of the 32 normal DMSA cases without changes, 81% did not present proteinuria and 88% continued to respond favorably to oxybutynin. GFR <90 ml/min/1.72m 2 was found in only 3 cases with abnormal DMSA. There was a RR 1.91 (IC95% 1.15-3.16) greater of renal compromise in cases that were anticholinergic-resistant compared to non-refractory cases. Over time, some patients suffered loss of bladder wall compliance, despite the proactive approach. There is an association between abnormal renal DMSA, reduced bladder capacity, and VUR at 5 years of age. Although proteinuria, CKD and enalapril requirement increased over 5 years, almost 90% did not show changes in renal DMSA status. Over time, some patients suffered loss of bladder wall compliance. Hence, even if a proactive approach is followed since birth, it is essential to continue with the ongoing monitoring of the renal status and thus avoid greater renal deterioration.

Renal Infarction Imaged With [18F]Prostate-Specific Membrane Antigen-1007 PET/CT.

A 61-year-old post-renal transplant man developed pain in the region of the allograft 4 days after transplantation. Contrast-enhanced CT scan revealed multiple small perfusion defects in the renal graft cortex. Multifocal renal cortical infarction was suspected. A [99mTc]Tc-DMSA SPECT/CT showed several small regions with decreased uptake. In addition, an [18F]PSMA-1007 PET/CT confirmed these uptake defects and revealed additional defects. The renal cortical infarctions presumably originated from intraoperative emboli emerging from the arterial anastomosis. Treatment with acetylsalicylic acid 100 mg led to favorable evolution of the renal function biochemically. Follow-up DMSA scintigraphy 3 months later showed resolution of the renal cortical defects.

The impact of Technetium-99m dimercapto-succinic acid scintigraphy on DNA damage and oxidative stress in children.

Technetium-99m-dimercapto succinic acid (Tc-99m DMSA) scintigraphy is a commonly used imaging modality in children with urological abnormalities. The radiopharmaceuticals, which have the effects of ionising radiation, are used in this method. This study aimed to investigate the impact of the Tc-99m DMSA scan on renal oxidative stress and mononuclear leukocyte (MNL) DNA damage. Children, who were followed up by paediatric nephrology at Bezmialem Vakif University and underwent Tc-99m DMSA scintigraphy between April 2015 and January 2016 with the indication of detection of renal scars, were included in this study. The exclusion criteria were nephrolithiasis, history of premature birth and recent urinary tract infection 3months prior to scintigraphy or antibiotic use in the last 1month. 3mL heparinised blood samples were obtained just before, immediately after and 1week after the scintigraphy. MNL DNA damage, total antioxidant status (TAS) and total oxidant status (TOS) were measured in the blood samples. The oxidative stress index (OSI) was calculated. Spot urine samples were obtained from each patient before and within 3days after performing the scintigraphy. TAS/Creatinine (TAS/Cr), TOS/Creatinine (TOS/Cr) and N-acetyl-glucosaminidase/creatinine (NAG/Cr) levels were measured in the urine samples. Twenty-seven children were evaluated. The values between TAS, TOS and OSI levels in serum samples at baseline, immediately after and 1week after the scintigraphy (P=.105, P=.913, and P=.721, respectively) showed no statistically significant difference. The levels of TAS/Cr, TOS/Cr, NAG/Cr ratios and OSI, which were evaluated from urine samples before and within 3days after the scintigraphy scan were also similar (P=.391, P=.543, P=.819 and P=.179, respectively). The levels of DNA damage only increased following scintigraphy scan and decreased a week later (P<.05). The effect of Tc-99m DMSA scintigraphy is insufficient to create oxidative damage, but it can cause DNA damage via the direct impact of ionising radiation which can be repaired again in a short time.

Role of Technetium-99m-Ethylenedicysteine in the Calculation of Differential Renal Function: A Comparison Study with Dimercaptosuccinic Acid Renal Scintigraphy.

Purpose of the Study:The aim of our study was to compare the technetium-99m (Tc-99m)-ethylenedicysteine (EC) renography calculation of differential renal function (DRF) with this measurement using Tc-99m-dimercaptosuccinic acid (DMSA) scintigraphy.Materials and Methods:Patients referred to our department were included in our study, and both DMSA and EC scans were performed for each patient according to the standard imaging protocols. A checklist was filled for each patient. Statistical analysis was performed using correlation and regression methods.Results:Forty-two patients (mean age: 3.6 ± 3.4 years), including 32 boys and 10 girls, participated in our study. The results of EC scintigraphy were significantly correlated with the values of DMSA scintigraphy (P < 0.001). Performing linear regression, EC renography significantly (P < 0.001) predicted the DRF as it was calculated by DMSA scintigraphy (R2 = 0.92, P < 0.001). This test was significant in both male and female subgroups (P < 0.001).Conclusions:Overall, our study findings were similar to the reported results in the other reviewed studies, showing that Tc-99m-EC can be considered as an alternative for DMSA scintigraphy, providing interchangeable results.

Interrater Reliability of 99mTc-DMSA Scintigraphy Performed as Planar Scan vs. SPECT/Low Dose CT for Diagnosing Renal Scarring in Children.

99mTc-dimercaptosuccinic acid (DMSA) scintigraphy is currently the method of choice for assessing renal scarring in children, but it is not established whether conducting the scan as a single photon emission tomography combined with low-dose CT (SPECT/ldCT) scan provides additional diagnostic benefits when compared to conventional planar scintigraphy. In the present study, we evaluated the interrater reliability of DMSA SPECT/ldCT vs. planar DMSA scintigraphy for diagnosing renal scarring. Methods: Two nuclear medicine physicians blinded to patient data retrospectively analysed all paediatric 99mTc-DMSA scintigraphes that were conducted in our department for the assessment of post pyelonephritis renal scarring between 2011 and 2016. All scintigraphies included both a planar scan and SPECT/ldCT, and were performed on either a Phillips Precedence 16 slice CT or a Siemens Symbia 16 slice CT. The readers were blinded to each other’s readings and to patient data, and assessed all scans dichotomously for evidence of renal scarring. For each scan, the readers further noted if they were confident in their interpretation. Results: A total of 46 pairs of planar SPECT/ldCT DMSA scans were included. The readers were unconfident about their interpretation of 40% of the planar scans and 5% of the SPECT/ldCT scans. The interrater agreement rate was 72% for planar scans and 91% for SPECT/ldCT, and the corresponding Cohen’s kappa values were 0.38 and 0.79. Conclusion: DMSA SPECT/ldCT is associated with higher reader confidence and interrater reliability than conventional planar DMSA scintigraphy for the assessment of post pyelonephritis renal scarring in children.

Estimation of renal scarring in children with lower urinary tract dysfunction by utilizing resampling technique and machine learning algorithms

Aim: Classical database methods may be inadequate for large data sets accumulating continuously. Machine learning (ML), one of the main subsets of artificial intelligence, may solve this problem and find the best solution for future problems by gaining experience from the present data in medical studies. A method that may show the correlation between clinical findings and renal scarring (RS) with high accuracy in patients with lower urinary tract dysfunction (LUTD) is needed. In this study, the aim is to establish a model for the prediction of RS in children with LUTD by using ML. Methods: Patients older than three years of age (n=114) who needed urodynamic study were included in the study. There were 47 variables in the data set. Variables such as symptomatic urinary tract infection, vesicoureteral reflux, bladder trabeculation, bladder wall thickness, abnormal DMSA scintigraphy, and the use of clean intermittent catheterization were recorded. Several ML techniques (MLT) were applied to estimate RS. Results: As a result of the comparisons, the highest accuracy rate according to the confusion matrix was obtained by the Extreme Gradient Boosting (XGB) algorithm (91.30%). In the balanced (SMOTE) data set, the highest accuracy rate was obtained by the Artificial Neural Network (ANN) algorithm (90.63%). According to the Receiver Operating Characteristic (ROC), the highest success rate was obtained by the ANN algorithm in the balanced (SMOTE) data set (90.78%). Conclusion: High accuracy rates obtained by MLT may suggest that MLT might provide a faster and accurate evaluation process in the estimation of RS in patients with LUTD.

P0305DIAGNOSTIC VALUE OF TGF-B-1 AND ANG II EXCRERION IN URINE IN CHILDREN WITH VESICOURETERAL REFLUX DEPENDING ON THE THERAPEUTIC APPROACH

Abstract Background and Aims to determine the diagnostic value of profibrogenic cytokines of transforming growth factor (TGF-β1) and angiotensin II (AngII) in urine to detect the severity of tubulointerstitial fibrosis in children with vesicoureteral reflux (VUR) depending on the therapeutic approach. Method 117 patients aged 3 to 16 years (mean age 10.2 ± 4.5, 70.1% of girls) with VUR were examined. The control group consisted of 20 healthy children. All children underwent a complete nephrological examination. The levels of TGF-β1 and AngII were determined in morning urine using the ELISA method and counted for urine creatinine. To identify the severity of the lesion of the renal parenchyma, a static DMSA scintigraphy was performed. Results depending on the therapeutic approach, the children were divided into 2 groups: 1 gr. - children on conservative treatment (63.2%), 2 gr. - children, after surgical correction of VUR (36.8%). In each group, 3 subgroups were identified depending on the development of tubulo-interstitial fibrosis according to DMSA: A subgr. - without signs of sclerosis (15.4%), B subgr. - 1-2 foci (44.74%) and C subgr - &amp;gt; 3-4 foci of sclerosis (40.1%). All patients with VUR had a high urinary excretion of TGF-β1/Cr and AngII/Cr when compared with the control group (p&amp;lt;0.05). Regardless of the therapeutic approach, in subgroups A (without foci of sclerosis) and B (1-2 foci of sclerosis), patients had a statistically significantly lower level of excretion of these cytokines when compared with patients from subgroup C (p &amp;lt;0.05). No significant difference was found in the urinary excretion of TGF-β1/Cr and AngII/Cr depending on the therapeutic approach. Conclusion we established a reliable dependence of the excretion of TGF-β1/Cr and AngII /Cr in the urine on the severity of tubulo-interstitial fibrosis according to DMSA scintigraphy in children with VUR. At the same time, we did not note the dependence of the excretion of TGF-β1/Cr and AngII/Cr in the urine on the method of the therapeutic approach. Therefore, the study of the excretion of TGF-β1/Cr and AngII/Cr in the urine as non-invasive markers can be used as a criterion for the progression of nephropathy in VUR, regardless of treatment methods.

Visualization of a pyelocaliceal diverticulum with [99mTc] DTPA and [99mTc] DMSA scintigraphy

Visualization of a pyelocaliceal diverticulum with [99mTc] DTPA and [99mTc] DMSA scintigraphy

A case of photomultiplier tube defect observed in gamma camera DMSA scintigraphy: The importance of regular quality controls

A case of photomultiplier tube defect observed in gamma camera DMSA scintigraphy: The importance of regular quality controls

Diffusion weighted imaging is a promising method to detect acute pyelonephritis in non-sedated free breathing infants

Urinary tract infection (UTI) is a common disease in infants. The initial evaluation includes imaging to identify risk factors for permanent renal damage, such as malformation and renal parenchymal involvement of the infection i.e. pyelonephritis. 99mTc-Dimercaptosuccinic acid (DMSA) scintigraphy is a well-established method for detection of pyelonephritis and renal damage, but has limitations in availability, spatial resolution, and detection of congenital malformations. Diffusion weighted magnetic resonance imaging (DWI) has been shown to have a high sensitivity for detection of pyelonephritis in children without the use of invasive procedures, contrast agents or ionizing radiation. How this method performs in young infants during non-sedated free breathing remains, however, to be investigated. To prospectively assess the feasibility and performance of DWI for detection of pyelonephritis in non-sedated free breathing infants. 32 children <6 months of age with first-time symptomatic UTI were examined with DWI and DMSA scintigraphy. The DWI examination was performed using a free breathing protocol without the use of sedation. Pyelonephritic lesions were registered for both methods by independent observers. Agreement between DWI and DMSA was evaluated. Consensus diagnosis was determined and compared to the DWI findings. The MRI and DMSA examinations were completed in 25 infants, with a median age of 1.7 (0.7-5.5) months. Focal uptake reductions were detected on the DMSA images in 12 (24%) of the 50 kidneys. The DWI method demonstrated a fair to good agreement with DMSA, k=0.50 (p<0.0001). The consensus diagnosis was pyelonephritis in eight (16%) of the 50 kidneys. DWI detected seven of the eight kidneys with pyelonephritis. No false positive findings were detected with DWI compared to consensus diagnosis. This study has shown an agreement between DWI and DMSA scintigraphy in the detection of pyelonephritis. Further validation of the performance of DWI, using a consensus diagnosis as a reference, confirmed the potential of the method. This feasibility study included a limited number of patients and the results need to be confirmed in a prospective study of a larger cohort. Free breathing DWI is a promising method for detection of pyelonephritic lesions in non-sedated infants.

The comparison of the resistivity index values in the ultrasonographic evaluation of a unilateral atrophic/hypoplastic kidney

Background In the study, we aimed to determine the sensitivity of the renal resistivity index (RI) in differentiating hypoplastic and atrophic kidneys in patients with small-sized kidneys, and to evaluate its capacity to predict the renal involvement confirmed by the DMSA scintigraphy. Material and methods We retrospectively reviewed the ultrasonography (US) and DMSA findings, and medical records of pediatric patients with unilateral diminutive kidneys followed between January 2017 and June 2018. The RI measurements were performed twice, and the mean RI was calculated for each kidney of all patients. Results Sixty-three (male/female, m/f = 28/35) pediatric patients aged 107.2 ± 49.4 months (range 14–206 months) were included in this study. The DMSA scintigraphy revealed abnormal changes to atrophic kidneys in 38 patients and hypoplastic kidneys in 25. There were no differences between the groups with atrophy and hypoplasia by age, gender, urine density, and creatinine. The patient group with atrophic kidneys had a mean RI of 0.55 ± 0.21, and patients with hypoplastic kidneys had a mean RI of 0.67 ± 0.03. The mean RI and systolic/diastolic rates of the patients with atrophy were significantly lower than of the patients with hypoplastic kidneys (p = 0.042 and p = 0.048, respectively). There was a positive correlation between RI and DFR in the group with atrophy (r = 0.461, p = 0.016), but this was not the case for the group with hypoplastic kidneys (r= −0.066, p = 0.889). Conclusions The resistivity index might be very useful for differentiating atrophy and hypoplasia in patients with unilateral small kidneys and can be used instead of scintigraphic evaluation.

The Efficacy of Tc-99m DMSA Scintigraphy in Children with Vesicoureteral Reflux Accompanying Frequent Urinary Tract Infection

Objective: Urinary tract infection is one of the most common diseases in childhood. Experimental studies have shown that renal damage due to urinary tract infection can be prevented by early diagnosis and treatment. The aim of this study was to evaluate the correlation between vesicoureteral reflux grade and Technetium-99m- dimercaptosuccinic acid scintigraphy in patients with frequent urinary tract infectionMethods Between January and October 2017, 34 cases were diagnosed as vescoureteral reflux with voiding cystoureterography were retrospectively evaluated with Technetium-99m- dimercaptosuccinic acid scintigraphy in terms of renal scar and function. Scars and function ratios were evaluated in Technetium-99m- dimercaptosuccinic acid scintigraphy according to voiding cystourethrography grades and correlation between the vesicoureteral reflux grade and Technetium-99m- dimercaptosuccinic acid scintigraphy findings were investigated.Results: Of 34 patients, 26 (76.5%) were female and 8 (23.5%) were male. The mean age of the patients was 6.08 ± 4.03 (min: 1 month, max: 17 years). Twenty-one patients had unilateral vesicoureteral reflux and 13 patients had bilateral vesicoureteral reflux. Vesicoureteral reflux were detected in 47 of the total 68 kidneys.Conclusion: In children with vesicoureteral reflux, Technetium-99m- dimercaptosuccinic acid scintigraphy provides useful information to show the kidney damage and as the vesicoureteral reflux grade increases, the rate of kidney damage increases. Even in the case of grade 1 and grade 2 vesicoureteral reflux, which are not expected to cause renal parenchymal damage. Technetium-99m- dimercaptosuccinic acid scintigraphy is the most successful imaging method for detecting parenchymal injury.

Evaluation of cyclic direct radionuclide cystography findings with DMSA scintigraphy results in children with a prior diagnosis of vesicoureteral reflux.

Direct radionuclide cystography (DRC) with cyclic imaging is a sensitive method used for the detection of vesicoureteral reflux (VUR). Radionuclide cystography is generally recommended for follow-up evaluation of VUR. The aim of this study was to evaluate cyclic DRC with DMSA scan results during the follow-up period in children with a prior diagnosis of VUR. DRC findings of 85 children with VUR were evaluated together with DMSA findings during follow-up. VUR grade was classified anatomically as grades I, II, and III reflux. Reflux grades of II and III were regarded as high-grade reflux. Reflux was also graded functionally as transient and continuous on the basis of the presence of reflux on either filling or voiding phases (transient) or both phases (continuous) of at least one cycle. Among 85 children, 32 (38%) exhibited reflux. In five patients, reflux was observed on both sides, and a total of 37 refluxing units (RUs) were evaluated. According to the highest grade attained in either cycle, 31 (84%) units had grade II, five had grade I and one had grade III reflux. Reflux was continuous in 23 (62%) and transient in 14 (38%) RUs. The incidence of an abnormal scan result was higher in continuous reflux group (78%) than in high-grade anatomic reflux group (59%). The addition of a second cycle resulted in the diagnosis of continuous reflux in six (26%) more RUs. DMSA scan findings correlated significantly with functional reflux classification (P<0.05), but not with anatomic reflux classification (P>0.05). Functional classification of VUR into continuous and transient reflux resulted in higher correlation with DMSA scan findings compared with anatomic reflux grading in follow-up patients with VUR. Cyclic imaging contributed to continuous reflux diagnosis. The significance of functional information obtained from cyclic DRC in initial diagnostic workup, management, and follow-up of children with urinary tract infection needs to be determined with further studies.

Resistive Index (RI) in Febrile Urinary Tract Infection: New Predictive Value

Background and Objective: Urinary tract infection is the most common bacterial infection in the pediatric population.The upper urinary tract infection involves the kidney parenchyma and may cause scarring and permanent damage that will proceed to cause hypertension and decreased kidney function. Almost third of cases will relapse following the first infection in one year. There are different imaging techniques that can help to detect children at risk for future infections, kidney scarring or other systemic complications. The Ultrasonography of bladder and kidneys: is a relatively cheap, non-invasive and fast test that enables to find children with anatomical anomalies that can be corrected to avoid future infections or complications. Also, this test does not pose the risk of radiation exposure. Voiding cystourethrogram: is the test of choice to establish the presence of vesicoureteral reflux that is a major risk factor for future infections and scaring. This test has a radiation exposure risk, it is invasive and relatively complex to perform. DMSA scintigraphy test: may be performed to determine acute pyelonephritis or to investigate kidney scarring. This test has a greater radiation exposure risk. But it cannot distinguish between dysplasia of a kidney or scarring. With the development and improvement of the imaging capabilities of Doppler ultrasonography, we can measure the Resistive Index, which is a sonographic value to assess the kidney function. The normal value of the resistive index is 0.6 and the normal upper limit is 0.7. The increase in this value is related to kidney artery stenosis, extreme hypertension, infants, and intrinsic kidney disease. Importance: In this work, we want to measure if the Resistive Index can predict kidney scarring. Participants: We followed after 71 cases of kids from 0 to 11 years old that was admitted to our hospital Baruch Padeh Medical Center, Poriya, in the diagnosis of Urinary tract infection.71 children participated in the full evaluation. 56 children were under 2 years of age, 8 were aged 2 to 4 years, and 7 were over 5 years or older; 18 were males and 53 were females. Design: The diagnosis was made on the base of clinical presentation, laboratory blood analysis, urinary analysis, and urinary cultures. We measured the Resistive index in all of these patients. And they did the ordinary US of kidney parenchyma, the DMSA study and a cystography by the accepted protocols of our department. Settings: All patients underwent Doppler within 72 hours of hospitalization. Before our conclusions, we divided the patients in the study by their age. Main outcome: In the first group under 2 years old, we found a moderate correlation between the RI and DMSA study. And there was a strong correlation between RI and cystography .In the second group above 4 years, we found a strong correlation between RI both to DMSA and cystography. Results: In all the age groups we examined there is a strong correlation between RI and positive findings in cystography to find reflux.

Normal Functioning Fused Pelvic Kidney: A Very Rare Renal Anomaly

This study highlights two cases having fused pelvic kidneys who were referred at this institute by clinicians/nephrologists for 99mTechnetium (99mTc) DMSA and DTPA renal scintigraphy. One case was 24 year old female and the other case was 21 year old male. Both cases were undergone ultrasonographic examination for correlative purpose before renal scintigraphy. Their urinary drainage system was assessed with DMSA and DTPA renal scintigraphy, showing normal functioning fused pelvic kidneys. The authors also used diuretic during DTPA renogram to exclude the true obstructive feature of urinary tract.TAJ 2016; 29(1): 55-57