Comparison of ultrasound and dimercaptosuccinic acid scintigraphy changes in acute pyelonephritis

Abstract

The strategy for morphological investigations in children with acute pyelonephritis (APN) remains debatable. We studied 70 children (median age 2.0 years) admitted with a first episode of pyelonephritis using a high-resolution ultrasound technique (RUS) and compared the results with 99m technetium-dimercaptosuccinic acid (DMSA) renal scintigraphy. The DMSA scan was abnormal in 62 children (89%). However, using a high-frequency transducer we found abnormal sonogram changes in 61 children (87%), consisting of an increased kidney volume in 42, and/or a thickening of the wall of the renal pelvis in 42, and/or a focal hyper- or hypoechogenicity in 36, and/or a diffuse hyperechogenicity in 31 children. Micturating cystourethrography was performed in all children, revealing vesicoureteral reflux (VUR) in 22 (31%). Among those children with VUR, 4 had a normal DMSA scan, 2 an abnormal RUS, and 2 a normal DMSA scan and RUS. Our data suggest that B-mode RUS performed with a high-frequency transducer by a trained radiologist is nearly as sensitive as the DMSA scan in diagnosing renal involvement in children with unobstructed APN and in predicting VUR.

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

“…116,126,148,201 Only six studies provided an adequate description of both the index test and the reference standard. 121,150,155,160,169,183 Eleven studies did not report sufficient information to assess avoidance of test review bias, 116,127,146,148,150,156,157,166,169,201,205 and six did not report sufficient information to assess avoidance of disease progression bias. 116,125,146,155,177,201 The remaining two evaluations of ultrasound techniques used inappropriate reference standard tests of clinical and laboratory diagnosis of APN 211 and computed tomography (CT).…”

“…All but one of the studies reported that disease progression bias had been avoided. 146 Only two studies provided sufficient details on how MCUG was performed to permit replication, 157,169,183 although all but one provided details on how the reference standard was performed. 157 Two studies reported that the MCUG results were interpreted without knowledge of the reference standard results, and that the reference standard results were interpreted without knowledge of the MCUG results.…”

“…157 Two studies reported that the MCUG results were interpreted without knowledge of the reference standard results, and that the reference standard results were interpreted without knowledge of the MCUG results. 183,208 A further study reported that the reference standard results were interpreted without knowledge of the MCUG results. 143 The remaining studies failed to report on blinding.…”

“…143,146,156,157,169,183,208 All of these studies used Tc-DMSA renal scintigraphy as the reference standard; six used acute DMSA and one used the presence or absence of renal scarring as determined by followup DMSA. The studies described in this section were generally poorly reported, and were of average methodological quality.…”

“…The diagnostic accuracy of ultrasound was assessed in 20 studies. 116,121,[125][126][127]134,146,148,150,[155][156][157]160,166,169,177,183,201,205,211 Renal scintigraphy was the reference standard in 18 of these studies, 116,121,[125][126][127]146,148,150,[155][156][157]160,166,169,177,183,201,205 with acute 99m Tc-DMSA used in 14 of these. Of the 18 ultrasound studies that used an appropriate reference standard, ten did not use an appropriate spectrum of patients, 116,121,127,148,150,[155][156][157]177,…”