Technetium-99m Dimercaptosuccinic Acid Scan Research Articles

Teknesyum-99m işaretli Dimerkaptosüksinik asit renal kortikal sintigrafi görüntülemede pelvik yerleşimli çapraz ektopik böbreği taklit eden deforme mesane aktivitesi

Technetium-99m dimercaptosuccinic acid (DMSA) scan was performed on a 32-year-old woman with 
 abdominal pain. A normal functioning slightly ptotic right kidney was seen on planar images. There 
 was no activity in the left renal region and a small fusiform activity was seen in the right pelvic area. 
 Pelvic computed tomography (CT) axial images revealed pre-vesical pelvic abscess pushing the 
 bladder posteriorly to the right side. On computed tomography images obtained after percutaneous 
 drainage it was concluded that the activity in the right pelvic area on Technetium-99m DMSA scan was 
 compatible with physiological activity in the bladder.

Low yield from imaging after non-E. coli urine tract infections in children treated in primary care and emergency department

BackgroundImaging is recommended for selected children following urinary tract infections (UTIs) to look for actionable structural abnormalities. Non-E. coli is considered high risk in many national guidelines, but evidence is...

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.

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.

Influence of early (F+0) intravenous furosemide injection on the split renal function using 99mTc-DTPA renography

In busy nuclear medicine departments, the F+0 protocol for diuretic renography is routinely used to shorten the acquisition time. The aim of this study was to evaluate the influence of the F+0 protocol on the split renal function (SRF) during a dynamic renal scan using technetium-99m diethylene triamine pentaacetic acid (Tc-DTPA) compared with that using the standard technetium-99m dimercaptosuccinic acid (Tc-DMSA). A total of 102 patients referred for a dynamic renal scan for varied etiologies were divided into two groups: the F+0 group, comprising 53 patients who were injected with furosemide just before Tc-DTPA injection, and the F+10 group, comprising 49 patients who were injected with the diuretic at the 10th minute after radiotracer injection. All patients were also subjected to a static cortical Tc-DMSA scan with geometric quantification of SRF. A highly significant statistical difference (P<0.001) was obtained on comparing the mean value of the difference in SRF calculated using DTPA and DMSA between the F+0 and F+10 groups, being 5.0±2.6 and 1.5±0.6%, respectively. All 49 patients in the F+10 group had a difference in split function of 5% or less, whereas 17/53 patients representing 32.1% of the F+0 group had a difference in SRF of greater than 5%. Early (F+0) furosemide injection before administration of Tc-DTPA has a significant influence on the estimation of SRF of the diseased kidney (either obstructed or functionally impaired) when compared with furosemide injection after standard Tc-DMSA administration. Care should be taken during interpretation of the scan findings when accurate split function is required.

Positioning irrigation of contrast cystography for diagnosis of occult vesicoureteric reflux: Association with technetium-99m dimercaptosuccinic acid scans

ObjectivePositioning irrigation of contrast (PIC) cystography identifies occult or PIC vesicoureteral reflux (PIC-VUR) in children with recurrent febrile urinary tract infections (UTI) but no vesicoureteric reflux (VUR) on standard voiding cystourethrogram (VCUG). We sought to identify the relationship between PIC-VUR and renal scarring in technetium-99m dimercaptosuccinic acid (DMSA) scans. Patients and methodsWe retrospectively analysed PIC cystograms and DMSA scans for 154 kidneys in 81 children (65 girls; 16 boys; median age, 4.7 years; range, 0.9–15.2). Renal scarring was graded on a scale of 0–3. DMSA scans were pathologic in 66 patients (81%). Children had experienced mean 3.8 febrile UTI (range 1–25). Forty-seven (58%) children had a history of reflux, including 15 (19%) with previous anti-reflux operations. Indications for PIC cystography were recurrence of febrile UTI after either bilateral negative VCUG (66 children) or unilateral VUR (15 children) with contralateral/bilateral scarring or reflux that had changed sides in subsequent VCUGs. ResultsPIC-VUR was bilateral in 63, unilateral in 12, and absent in 6 children. Statistically significant associations between PIC-VUR grade and severity of renal scarring were identified in inter-individual (n = 77, p = 0.017) and intra-individual (refluxing vs. nonrefluxing kidney; n = 12, p = 0.008) analyses. After excluding patients with history of VUR, statistical significance was maintained in inter-individual analysis (n = 49; p = 0.018). ConclusionThe data suggest an association between PIC-VUR and severity of renal scarring, and legitimise the use of PIC cystography in children with renal scarring due to recurrent febrile UTI but negative findings on VCUG.

Independent risk factors for renal damage in a series of primary vesicoureteral reflux: A multivariate analysis

The aim of this study was to investigate risk factors associated with different extents of renal parenchyma involvement in a paediatric series of primary vesicoureteral reflux (VUR). A total of 549 patients with VUR were analyzed. The variable of interest was renal scar, assessed by technetium-99m dimercaptosuccinic acid scan, and classified into three subtypes: focal scar, multiple cortical scarring and diffuse scars with a contracted renal unit. The multinomial regression model was applied to identify independent variables associated with each subtype of renal damage. After adjustment, four variables remained independently associated with a contracted renal unit: reflux grades III-V (odds ratio (OR)=9.7; 95% confidence interval (CI) = 4.1-21.0), age at diagnosis (OR=3; 95% CI=1.6-5.1), unilateral reflux (OR=2.1; 95% CI=1.2-3.8), and male sex (OR=2; 95% CI=1.1-3.8). Two variables were associated with multiple scars: reflux grades III-V (OR=13.8; 95% CI=7.4-26.0) and age at diagnosis (OR=1.9; 95% CI=1.2-3.0). Two variables were associated with a focal scar: reflux grades III-V (OR=7.9, 95% CI CI=3.8-16.4) and male sex as a protective factor (OR=0.5; 95% CI=0.25-1.0). Our findings suggest that the development of a contracted renal unit is probably due to congenital malformation, more commonly observed in male infants with high-grade reflux.