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Interobserver variability for interpretation of DMSA scans in the RIVUR trial.

Tej K Mattoo1, Steven J Skoog2, Lisa Gravens-Mueller3

  • 1Nephrology and Hypertension, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA.

Journal of Pediatric Urology
|July 17, 2017
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Summary
This summary is machine-generated.

Interobserver variability in reporting Technetium-99m dimercaptosuccinic acid (DMSA) renal scans for scarring and pyelonephritis was significant in the RIVUR trial. Standardized interpretation guidelines are needed to optimize DMSA scan clinical utility.

Keywords:
DMSA scanPyelonephritisReflux nephropathyRenal scarringVesicoureteral reflux

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Area of Science:

  • Pediatric Nephrology
  • Diagnostic Imaging
  • Radiology

Background:

  • Technetium-99m dimercaptosuccinic acid (DMSA) renal scans are crucial for diagnosing renal scarring in children.
  • The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial utilized DMSA scans to assess renal scarring in 607 children.

Purpose of the Study:

  • To quantify interobserver variability in the interpretation of DMSA renal scans within the RIVUR trial.
  • To compare local radiologist interpretations with reference radiologist assessments for DMSA scans.

Main Methods:

  • DMSA scan reports from local radiologists (ALRs) were compared against adjudicated reports from two reference radiologists (RRs).
  • Analyses included assessments of renal scarring and acute pyelonephritis.
  • Unweighted kappa statistics were used to analyze agreement between ALRs and RRs.

Main Results:

  • Reference radiologists identified 4% of kidneys with scarring, versus 7% by local radiologists.
  • Local radiologists' scar grading was upgraded (24%) or downgraded (55%) by reference radiologists.
  • For acute pyelonephritis, reference radiologists identified 3% of kidneys, versus 5% by local radiologists, with significant grading discrepancies.

Conclusions:

  • Significant interobserver variability exists in reporting DMSA renal scans, exceeding that in prior studies.
  • Lack of uniform reporting practices among local radiologists was a key limitation.
  • Optimizing DMSA scan clinical value necessitates standardized interpretation guidelines.