PURPOSE This study assessed the role of renal power Doppler ultrasonography (PDU) to identify acute pyelonephritis (APN) and to determine whether PDU can replace Tc-99m DMSA renal scintigraphy in the diagnosis of APN in children. METHODS A prospective study was conducted in 40 infants and young children (78 kidneys were evaluated) with a mean age of 25.9 months (range, 1 to 68 months) who were hospitalized with a first episode of high fever and bacteruria, possibly APN. All children were examined by PDU and Tc-99m DMSA within the first 3 days after admission. Patients with congenital abnormalities, hydronephrosis, and urinary reflux were excluded. RESULTS Twenty-seven of the 78 kidneys appeared abnormal on Tc-99m DMSA, and 20 of them were abnormal on PDU. Fifty-one of 78 kidneys were normal on Tc-99m DMSA, and 3 of 51 appeared diseased on PDU. The accuracy of PDU was 87%, sensitivity was 74%, and specificity was 94%. The positive predictive and negative predictive values were both 87%. When considering the numbers of lesions in 27 kidneys with positive Tc-99m DMSA studies (38 lesions), PDU did not disclose 16 lesions (false-negative results). Thus, the sensitivity of PDU for diagnosing lesions of APN decreased to 58%. CONCLUSIONS A positive PDU finding should obviate the use of Tc-99m DMSA in patients thought to have possible APN. However, because of a large number of false-negative results (26%) and underestimation of the number of pyelonephritic lesions (low sensitivity of 58%), PDU cannot replace Tc-99m DMSA in the diagnosis of APN in children.

Studies of pathology have shown that involvement of the right ventricle (RV) in acute myocardial infarction (AMI) is relatively common. Our experience in the noninvasive diagnosis of RVAMI and its early prognosis is presented. Sixty patients with AMI were prospectively studied: 40 patients with inferior AMI and 20 patients with anterior AMI. The evaluation was made by: (1) CLINICAL FINDINGS: hypotension, congestive heart failure, sinus bradycardia less than 40/min, dysrhythmia, and conduction disturbances; (2) ECG record including precordial lead (V4R); (3) Radioisotope heart scintigraphy: 99mTc-PYP infarct scintigraphy and multigated acquisition MUGA blood pool scanning. Of the 40 patients diagnosed as having inferior AMI, 20 cases (50%) were found to be associated with RVAMI. All of them were diagnosed by positive radionuclide studies, and 17 (85%) also demonstrated a ST segment elevation of 0.1 mV, and pathological Q waves in the V4R lead. The ejection fraction (EF) of RV was found to be significantly decreased in patients with RVAMI compared with the other group (mean, 27% versus 57%). Among the 20 patients with RVAMI, 16 (80%) showed various complications during the hospitalization period, versus 9 patients (45%) from the group with inferior AMI. The most common complication in RVAMI patients was conduction disturbances (7 of 20 versus 2 of 20 patients). The clinical and prognostic importance of the early diagnosis of RVAMI is stressed.

A patient suffering from malignant external otitis (MEO) underwent early blood pool scanning followed after 2 hours by 99m To MDP bone scanning, and serial Ga-67 citrate scintigraphies of the skull. The former two procedures served as a diagnostic tool to MEO. The latter was used for estimating the extent of the infective process, and for following-up the efficacy of treatment.The complementary role of these three procedures in the diagnosis, and follow-up of MEO, with special emphasis on immediate blood pool scanning as part of the diagnostic procedure, is illustrated.

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