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Published on: October 12, 2017
DMSA scan for revealing vesicoureteral reflux in young children with urinary tract infection
Sotirios Fouzas1, Erifyli Krikelli, Pavlos Vassilakos
1University Hospital of Patras, Department of Pediatrics, Rio, Patras, 265 04, Greece. sfouzas@gmail.com
Insights
Acute dimercaptosuccinic acid (DMSA) scintigraphy has limited ability to detect vesicoureteral reflux (VUR) in young children after a first febrile urinary tract infection (UTI). Voiding cystourethrography remains the preferred diagnostic tool for VUR evaluation.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Febrile urinary tract infections (UTIs) in young children can indicate underlying kidney abnormalities.
- Vesicoureteral reflux (VUR) is a significant risk factor for renal scarring and recurrent UTIs.
- Accurate diagnosis of VUR is crucial for appropriate management and prevention of complications.
Purpose of the Study:
- To evaluate the diagnostic performance of acute dimercaptosuccinic acid (DMSA) scintigraphy in detecting VUR.
- To compare the efficacy of DMSA scintigraphy with voiding cystourethrography (VCUG) in children under 24 months with a first febrile UTI.
Main Methods:
- A cohort of 296 children aged 24 months or younger with a first febrile UTI were retrospectively analyzed.
- Acute DMSA scintigraphy findings were compared with those of VCUG to assess VUR detection.
- Statistical analysis included calculating odds ratios, areas under the curve (AUC), and likelihood ratios (LR) for VUR detection.
Main Results:
- Abnormal DMSA scans showed an increased odds ratio for both dilating (4.36) and severe (5.50) VUR.
- The AUC for detecting dilating VUR was 0.68 and for severe VUR was 0.69.
- Even with normal DMSA and ultrasonography, some children had VUR, highlighting limited sensitivity.
Conclusions:
- Acute DMSA scintigraphy demonstrates limited overall accuracy in identifying VUR in young children.
- DMSA scintigraphy should not replace VCUG as the primary diagnostic method for VUR in this population.
- Further investigation may be needed to optimize diagnostic strategies for febrile UTIs in infants.
Objectives:
The objective of this study was to assess the ability of acute dimercaptosuccinic acid (DMSA) scintigraphy for revealing vesicoureteral reflux (VUR) in young children after a first febrile urinary tract infection (UTI).
Methods:
Children aged
Results:
Of the 296 children included, 46 had dilating and 25 severe VUR. Abnormal DMSA scan results were associated with an odds ratio of 4.36 for dilating and 5.50 for severe VUR. For detecting dilating VUR, the area under the curve (AUC) was 0.68, the positive likelihood ratio (LR) was 2.00, and the negative LR was 0.46; for severe VUR, those values were 0.69, 2.10, and 0.38, respectively. Children with abnormal DMSA scan results combined with abnormal ultrasonography had an odds ratio of 3.60 for dilating and 6.32 for severe VUR. Despite normal findings on both investigations, 12 children had dilating and 4 severe VUR. For dilating VUR, the area under the (AUC) was 0.65, the positive LR was 1.70, and the negative LR was 0.47; for severe VUR, the values were 0.69, 1.90, and 0.29, respectively.
Conclusions:
Our data suggest that acute DMSA scintigraphy has limited overall ability in identifying VUR and should not be endorsed as replacement for voiding cystourethrography in the evaluation of young children with a first febrile UTI.
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