Renal single photon emission computed tomography: Should we do it?

Williams, E. D.

doi:10.1016/s0001-2998(05)80086-8

Cited by 13 publications

(5 citation statements)

References 30 publications

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“…Also, it is widely recognized that the kidneys have rather heterogenous uptake of radiotracer due to their anatomic structure. Frequent causes of false positives in children include the columns of Bertin that differ in one individual and between the individuals, and cortical thickness ununified in one kidney (6, 9). …”

Section: Discussionmentioning

confidence: 99%

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Interobserver Variability in Interpretation of Planar and SPECT Tc-99m-DMSA Renal Scintigraphy in Children

Bešlić¹,

Milardović²,

Šadija³

et al. 2017

Acta Inform Med

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Objective:This study objective was to evaluate interobserver agreement between individual pairs of three nuclear medicine physicians in interpretation of renal cortical scintigraphy in children with respect to the mode of acquisition (planar vs. SPECT), diagnoses and kidney site (left vs. right).Materials and Methods:Thirty children were imaged in planar and SPECT mode per protocol upon the injection of Tc-99m DMSA dose adjusted to their body weight. Patients were classified according to diagnoses into four groups. Three nuclear medicine physicians interpreted the findings blindly and independently. Renal defects were interpreted as focal and diffuse, per three renal segments. For the raters we calculated simple percentage agreement, the Cohen kappa statistic with 95% confidence intervals, and the overall kappa defining the levels of reliability as almost perfect or perfect, substantial, moderate, fair and slight agreement.Results:Interobserver agreement in planar interpretation was 77,2% (kappa=0.59; 95% confidence interval, 0.41 to 0.75) and SPECT 72,9% (kappa= 0,57; 95% confidence interval, 0,41 to 0,72). In planar interpretation, all individual pairs had moderate agreements except one that had a substantial agreement. In SPECT, all the pairs had moderate agreements except one that had an almost perfect agreement. Overall agreement per kidney site was on planar 73,4% for the left (kappa=0,54, moderate agreement), and 81,1% for the right kidney (kappa 0,63, substantial agreement). On SPECT, there was 72,2% agreement for the left (kappa=0,59, mode rate agreement), and 73,7% for the right kidney (kappa=0,54, moderate agreement). Overall agreement per diagnoses ranged from 70-88,9% on planar (kappa= -0,04 to 0,79), and 50-100% on SPECT (kappa=-0,02-1,000) indicating agreements from slight to substantial.Discussion:Our results suggest acceptable levels of interobserver agreement in all individual pairs of raters with respect to the mode of acquisition (planar vs. SPECT), diagnoses and kidney site (left vs. right). For the mode of acquisition, we would recommend hybrid imaging SPECT/CT method to be used whenever possible in the detection of renal cortical defects on Tc-99m-DMSA scintigraphy.

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Section: Discussionmentioning

confidence: 99%

“…Specificities of the kidneys relate to rather heterogenous physiologic uptake of radiotracer, which creates higher contrast resolution and better delineation of the lesions (5, 6). Specificities of pediatric kidneys relate to developmental changes and smaller kidney size in general.…”

Section: Introductionmentioning

confidence: 99%

Interobserver Variability in Interpretation of Planar and SPECT Tc-99m-DMSA Renal Scintigraphy in Children

Bešlić¹,

Milardović²,

Šadija³

et al. 2017

Acta Inform Med

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“…SPECT imaging is superior to simple planar imaging, Itoh et al [23] reported SPECT imaging detecting RCD at greater frequency than previously achieved, Williams [24] claimed that SPECT has useful applications in detecting and classifying renal scarring, although it had little advan tage over conventional imaging in investigating space-occu pying lesions and anatomic abnormalities, and good for quantitative studies of renal uptake and volume. In our study, 25% (4/16) of multiple RCDs observed by SPECT image were missed on planar image.…”

Section: Discussionmentioning

confidence: 99%

Clinical Value of DMSA Planar and Single Photon Emission Computed Tomography as an Initial Diagnostic Tool in Adult Women with Recurrent Acute Pyelonephritis

Kim

Yang

Ryu

et al. 1994

Nephron

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Routine DMSA scintigraphy, ultrasound (US) of the kidney, intravenous pyelography (IVP) and voiding cystoureterography (VCU) were performed in 27 consecutive adult women with recurrent acute pyelonephritis (APN) during a 12-month follow-up. Both planar and single photon emission computed tomography (SPECT) images were obtained for DMSA scan. DMSA scans were repeated in those patients with abnormal initial scan. DMSA-SPECT showed normal findings in 2, single renal cortical detect (RCD) in 9 and multiple RCD in 16 (including nonvisualization in 2). Of the 11 kidneys with normal findings or single RCD on DMSA-SPECT, only 1 (9%) showed vesicoureteral reflux (VUR) on VCU (grade I). A large proportion of those with multiple RCDs showed abnormal findings on IVP (44%, 7/16), US (38%, 6/16) or VCU (31%, 5/16); 63% in any of these three studies. 5 of 6 patients with VUR had multiple RCDs on DMSA-SPECT, and 3 of these 5 showed no abnormality on IVP or US. 7 patients who needed other managements besides initial standard antibiotic treatment had multiple RCDs on DMSA-SPECT. 15 normal women were also studied and showed normal DMSA-SPECT, US and IVP, in all cases. Follow-up DMSA-SPECT was done in 16 patients (7 with single RCD, 9 with multiple RCD). All 7 patients with single RCD showed improvement, in those with multiple RCDs improvement was observed in 2, no change in 7 on follow-up studies. We conclude: (1) DMSA-SPECT is a useful initial diagnostic tool in adult women with recurrent APN to identify patients who need more extensive radiological studies. (2) The multiple RCDs on DMSA-SPECT indicate irreversible tissue damage in most adult women with recurrent APN.

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“…Better delineation of the lesions can be obtained using pinhole scintigraphy; some authors have proposed the use of high-resolution SPECT (Joseph et al 1990;Tarkington et al 1990;Yen et al 1996). Despite experimental evidence that SPECT is more accurate than planar imaging in the diagnosis of acute pyelonephritis (Giblin et al 1993), its benefit in patients looks rather marginal and it seems mainly useful in assessing scarring (Williams 1992). Furthermore, a study in normal volunteers demonstrated abnormalities on SPECT images with entirely normal planar images (de Sadeleer et al 1996): systematic use of SPECT carries the risk of over-diagnosing either acute cortical defects or scars.…”

Section: Renal Cortical Imagingmentioning

confidence: 99%