Value of comprehensive renal ultrasound in children with acute urinary tract infection for assessment of renal involvement: comparison with DMSA scintigraphy and final diagnosis

Abstract

The aim of this study was to evaluate the value of comprehensive renal ultrasound (US), i.e., combining greyscale US and amplitude-coded color Doppler sonography (aCDS), for assessment of urinary tract infection (UTI) in infants and children, compared to (1) (99m)Tc DMSA scintigraphy and (2) final diagnosis. Two hundred eighty-seven children with UTI underwent renal comprehensive US and DMSA scintigraphy. The results were compared with regard to their reliability to diagnose renal involvement, using (1) DMSA scintigraphy and (2) final diagnosis as the gold standard. Sixty-seven children clinically had renal involvement. Sensitivity increased from 84.1% using only aCDS to 92.1% for the combined US approach, using DMSA scintigraphy as the reference standard. When correlated with the final diagnosis, sensitivity for DMSA scintigraphy was 92.5%; sensitivity for comprehensive US was 94.0%. Our data demonstrate an increasing sensitivity using the combination of renal greyscale US supplemented by aCDS for differentiation of upper from lower UTI. Sensitivity for DMSA and comprehensive US was similar for both methods compared to the final diagnosis. Comprehensive US should gain a more important role in the imaging algorithm of children with acute UTI, thereby reducing the radiation burden.

Recurrent urinary tract infections in young children: role of DMSA scintigraphy in detecting vesicoureteric reflux

“…The traditional "bottom-up" approach utilizes US followed by MCUG to detect possible vesicoureteric reflux in children with a first febrile urinary tract infection. [8] On the other hand, the newer top-down approach starts with a screening DMSA scan followed by MCUG only in selected cases [9,10]. Each approach has its own advantages and disadvantages [4,11].…”

Association of Vesicoureteric Reflux (VUR) in Children with Symptomatic Urinary Tract Infection (UTI) - in a Tertiary Care Hospital, Dhaka, Bangladesh

“…10 Some authors found important indications of doing USG in evaluation of UTI. 26,27 But others showed that it is not sensitive nor specific for detection of VUR in children with first UTI. 28,29 Even though it is done routinely in some centers for evaluation of lower urinary tract in children with first UTI to exclude congenital anomalies particularly when the prenatal USG evaluation was absent.…”

The Pediatric Kidney

“…In our experience, comprehensive US in conjunction with clinical and laboratory information can reliably establish the diagnosis of lower or upper urinary tract infection in the majority of cases, thus obviating the need for further investigations in a large number of children (Brader et al 2008 ).…”