Tc-99m DMSA Renal Scintigraphy Research Articles

Is technetium-99m dimercaptosuccinic acid renal scintigraphy available for predicting vesicoureteral reflux in children with first febrile urinary tract infection under the age of 24 months?

Vesicoureteral reflux (VUR) is a common complication after urinary tract infection (UTI) and can lead to irreversible renal scar. Voiding cystourethrogram is the most reliable technology to detect VUR and its severity, but it is restricted in children's examinations for various shortcomings. This study aimed to evaluate and compare the efficiency of Tc-99m DMSA renal scintigraphy and conventional ultrasonography (USG) in predicting VUR with the gold standard of cystourethrogram results. This retrospective study consisted of 285 first febrile UTI children under the age of 24 months who completed inflammatory indicator examinations, USG, Tc-99m DMSA renal scintigraphy and underwent cystourethrography after controlling infection with prophylactic antibiotics. The efficiency of Tc-99m DMSA renal scintigraphy and USG in predicting VUR was calculated and compared. Abnormal USG (40.23% vs. 21.72%, P = 0.001) and Tc-99m DMSA renal scintigraphy results (87.36% vs. 71.72%, P = 0.004) were more common in VUR children. The sensitivity of USG in predicting VUR was only 40.23%, whereas the sensitivity and negative predictive value of Tc-99m DMSA renal scintigraphy reached 87.63 and 83.58%, respectively. Tc-99m DMSA renal scintigraphy had a higher efficacy than USG in predicting high-grade reflux kidneys (73.87% vs. 33.33%; P < 0.001), but there was no significant difference in predicting low-grade reflux kidneys ( P = 0.703). Tc-99m DMSA renal scintigraphy had a significant higher efficiency in predicting VUR (a common cause of renal scarring, detected on DMSA) in first febrile urinary tract infection children under the age of 24 months as compared with USG, especially in high-grade reflux.

Laparoscopic pyeloplasty as an alternative to nephrectomy in adults with poorly functioning kidneys due to ureteropelvic junction obstruction

To evaluate outcomes of laparoscopic pyeloplasty (LP) in adults with poorly functioning kidney due to ureteropelvic junction obstruction (UPJO). A retrospective comparative analysis was performed between adult patients who underwent LP due to UPJO with differential renal function (DRF) ≤ 15% and DRF > 15%. LP success rate and complications were assessed. LP success was defined as symptoms improvement and DRF improvement or stabilization. DRF and estimated glomerular filtration rate (eGFR) were analyzed before and 12months after surgery to evaluate renal function recovery. DRF was estimated using Tc-99m DMSA renal scintigraphy. Among 121 LP performed in the study period at our institution, 15 and 42 were included in the DRF ≤ 15% and DRF > 15% groups, respectively. At a median follow-up of 17.8months, all patients with DRF ≤ 15% reported symptoms improvement. LP success rate was 86.7% and 90.5% (p = 0.65) for patients with DRF ≤ 15% and DRF > 15%, respectively. There were no complications in the DRF ≤ 15% group, while there were three complications recorded in the DRF > 15% group (Clavien 2 and 3b). In the DRF ≤ 15% group, mean pre-operative and post-operative DRF was 9.5% ± 3.6 and 10.5% ± 7.8 (p = 0.49), respectively. Median pre-operative and post-operative eGFR was 68.5ml/min and 79.8ml/min (p = 0.93), respectively. Two patients had DRF improvement after LP. LP in adult patients with UPJO and poor function kidneys is an effective and safe procedure. DRF recovery is seen in a minority of the patients; however, LP is an alternative to nephrectomy.

Classical vs. unit area method in the evaluation of differential renal function in unilateral hydronephrosis.

There are some problematic results in determination of differential renal function (DRF) by means of Tc-99m DMSA renal scintigraphy in hydronephrotic kidneys. In this study the classical method (CM) and unit area methods (UAM) in the estimation of DRF in unilateral hydronephrosis before and after intervention were compared. Twenty patients (12 M, 8 F; mean: 42.6±18.5 years old) who were candidates for surgery or intervention because of unilateral hydronephrosis were the subjects of this study. All the patients were evaluated by Tc-99m DMSA scintigraphy before and 3-6 months after the intervention. In order to estimate DRF both CM and UAM (obtained by division of the counts including the kidney ROI to pixel of the same ROI) were performed. Bland-Altman analyses were performed in order to compare the DRF values obtained from both methods. The agreement between CM and UAM was poor in the preoperative estimation, however, the agreement was good after the operation or intervention. In this study it seems that DRF estimation with CM in unilateral hydronephrosis might be problematic in the determination of surgery thus UAM might be introduced as the method of choice in the determination of DRF in unilateral hyronephrosis.

Diagnostic role of initial renal cortical scintigraphy in children with the first episode of acute pyelonephritis

Assessment of the first febrile urinary tract infection (UTI) in children has been the subject of debate for many years. Diagnosis of acute pyelonephritis (APN) is usually based on clinical and biological data. The clinical usefulness of early Tc-99m DMSA scintigraphy remains controversial, although it may influence the type and duration of treatment. The aim of this study was to assess the role of initial cortical scintigraphy in the detection of early renal parenchymal damage in children highly suspected of having APN and to compare the scintigraphic findings with selected clinical/laboratory parameters and ultrasonography. A prospective study was conducted in 34 infants and young children (18 boys, 16 girls), aged 1.5-36 months (mean 9.8 ± 8.7 months), hospitalized with a first episode of clinically suspected APN. Within the first 5 days after admission, Tc-99m DMSA renal scintigraphy, ultrasonography (US), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), white blood cell count (WBC) and urine analyses were performed. DMSA scintigraphy showed changes consistent with APN in 27/34 (79%) patients, with a mean age of 10.9 months, including 12 males (44%) and 15 (56%) females. Out of 9 febrile children with negative urine culture and supportive evidence of UTI, scintigraphy showed parenchymal involvement in 8 children (24% in the whole group, 30% in scintigraphically documented APN). There were no statistically significant correlations between the frequency or size of the initial scintigraphic abnormalities and age, sex, body temperature, CRP levels or ESR. A CRP level of >54 mg/L and a WBC of >13,300/mm³ had sensitivities of 56 and 59% and specificities of 86 and 71%, respectively. US showed changes consistent with APN in 7/34 (21%) in the whole group and in 7/27 (26%) patients with positive cortical scan (p < 0.05). Initial DMSA renal scintigraphy is a sensitive method for the early diagnosis of APN in young children and is useful in the assessment of the severity of kidney injury even in patients with negative urine culture. Clinical, biological and ultrasound parameters do not identify children with renal damage. Normal DMSA study, excluding parenchymal involvement and late sequelae, could minimize the use of scintigraphy in the follow-up and reduce the redundancy of cystography.

Renal scintigraphy in children with urinary tract infections

To determine the incidence of abnormal Technetium Tc 99m Dimercaptosuccinic Acid (Tc99m DMSA) renal scintigraphy findings in the children with urinary tract infection (UTI), and to evaluate the difference between the children with UTI and vesico-ureteral reflux (VUR), and the children with UTI without VUR. Tc99m DMSA renal scintigraphy was performed in 170 children with UTI, mean age 7.07 years (1 month to 14 years, 137 were girls and 33 were boys). In 88 of the children, VUR was proved by micturating cystouretherography (MCU), while in 82 VUR could not be detected by MCU. VUR was graded in accordance with MCU recommended by the intemational study of VUR. In 13 of the children the grade of VUR was grade I, in 30 was grade II, in 23 grade III, in 17 grade IV, while the grade V was in 5 of the children. Findings of Tc99m DMSA renal scintigraphy were classified as: 1--normal, 2--probably normal, 3--equivocal, 4--probably abnormal, and 5--abnormal. The degree of the significance of the difference of the findings was estimated using chi2, taking p < 0.01 as the limit of statistical significance. Of the total number of 170 studied children, the abnormal findings were detected in 30% (51/170), normal findings in 62% (106/170), and equivocal in 8% (13/170). In the children with UTI and VUR, the incidence of abnormal findings was 49% (43/88), of normal 43% (38/88), and of equivocal findings 8% (7/88). All the children with VUR grade V had the abnormal findings (the incidence of the abnormal findings was 100%). In the children with VUR grade IV, the abnormal findings were 71%. In the children with VUR grade I, 77% of the findings were normal, in the children with VUR grade II 53% of the findings were normal and in the children with VUR grade III, 30% otfthe findings of renal scintigraphy were normal. In the children with UTI without VUR, the incidence of abnormal findings was 10% (8/82), of normal findings 83% (68/82), and of equivocal findings 7% (6/82). The incidence of abnormal findings was significantly higher in the children with UTI and VUR than in those with UTI without VUR (p < 0.01). Also, the incidence of the abnormal findings was higher in the children with VUR grades IV and V than in the children with VUR grade I (p < 0.01). DMSA renal scintigraphy in the children with ITU revealed the abnormal findings in 30% of the cases. The incidence of the abnormallfindings was signficantly higher when VUR was present, as well as if the grade of VUR was higher. Our results confirmed that Tc99m DMSA renal scintigraphy was a very important technique in the evaluation of the children with ITU.

Utilising quantitative TC 99M-DMSA renal scintigraphy to predict postoperative renal failure in patients undergoing radical nephrectomy

Utilising quantitative TC 99M-DMSA renal scintigraphy to predict postoperative renal failure in patients undergoing radical nephrectomy

The Grade of Vesicoureteral Reflux in Voiding cystourethrography: Comparison with Ultrasonography and Tc99m-DMSA renal Scintigraphy

The Grade of Vesicoureteral Reflux in Voiding cystourethrography: Comparison with Ultrasonography and Tc99m-DMSA renal Scintigraphy

Tc-99m DMSA renal scintigraphy during kidney maturation.

A total of 282 renal scintigrams with Tc-99m DMSA in 238 children ranging in age from 10 days to 13 years performed during a 3-year period were reviewed. The authors present 94 kidneys in 85 children in whom no sign of pathology was demonstrated clinically, either by ultrasound or intravenous urography, or by micturating urethrocystography. By exploring homogeneity or heterogeneity of tracer distribution, kidney length, and background level, the authors were able to identify a "normal" pattern of tracer distribution according to age. They found that the average kidney length was 56 mm at birth, growing 1 mm per month during the first year of life, and 4 mm per year thereafter, until puberty. Average background activity was 14% of the average kidney activity at birth which decreased to approximately 6% during the first year of life, with no further decrease thereafter.

Relevance of Tc-99m DMSA scintigraphy in renal transplant parenchymal imaging.

Tc-99m DMSA renal scintigraphy was performed in 40 renal grafts. Cyclosporin A and glucocorticoids were given to all patients as antirejection therapy, and 11 also were given azathioprine. The kidneys were transplanted 1 to 97 months before the investigation. Seventy percent of kidneys had diffusely altered distribution of Tc-99m DMSA, and 43% had focal clear-cut parenchymal defects. The frequency of parenchymal defects observed on the DMSA scans was higher in patients who suffered manifest acute rejection episodes (8/16 versus 9/24 patients, borderline significance, P < 0.06), but had no relation to the living or cadaveric donor transplant or its function. A combination of peritubular edema and interstitial fibrosis is considered the most probable explanation of diffuse changes. The high frequency of clear-cut parenchymal defects most likely results from symptomatic or asymptomatic rejection episodes complicated by renal transplant infarcts.

Cintigrafía renal con Tc99m DMSA (Acido dimercaptosuccínico) en pielonefritis aguda

Twenty patients, 6 months to 11 year old, with clinically recognized acute pyelonephritis, were evaluated with Tc99m DMSA renal scintigraphy in the first 15 days of their illness to validate this method in the detection of the acute renal inflammatory disease. In 85% of Tc99m DMSA scintigraphies some kind of abnormality (focal or diffuse, unilateral or bilateral) was observed. Second renal images obtained at an average 8.5 months later, showed total disappearance of abnormal findings in 42%; partial regression in 50% and no changes in 8% of these cases. Tc99m DMSA scintigraphy seems to be a good diagnostic tool to confirm acute renal compromise in urinary tract infections. Besides follow up examinations, at least three months later with this same method, were able to confirm sustained renal lesions.