Renal Cortical Imaging with Tc-99m DMSA in Children: An Institutional Review

Area of Science:

• Pediatric Nephrology
• Nuclear Medicine
• Pediatric Urology

Background:

• Urinary tract infection (UTI) is a common pediatric condition.
• Dimercaptosuccinic acid (DMSA) scintigraphy evaluates renal cortex function and morphology, detecting parenchymal defects often missed by ultrasound.
• This study investigates DMSA scintigraphy in children to identify factors associated with cortical defects.

Purpose of the Study:

• To examine DMSA scintigraphy findings in children.
• To identify factors associated with renal cortical defects in pediatric patients.
• To assess the relationship between vesicoureteric refluxes (VURs) and DMSA scintigraphy results.

Main Methods:

• Retrospective analysis of 30 children (≤ 18 years) who underwent DMSA scintigraphy between November 2019 and February 2023.
• Intravenous injection of 99mTc-DMSA followed by static planar and SPECT imaging.
• Grading of cortical findings and differential renal function based on established criteria.

Main Results:

• The majority of patients were female (53%) with a mean age of 5.85 years; 73% had UTI episodes.
• Twenty-two children had congenital urinary tract anomalies, and all patients with VURs showed positive defects.
• Abnormal DMSA scintigraphy was observed in 17 children, with VURs significantly associated with abnormal findings and impaired differential renal function (p < 0.05).

Conclusions:

• Vesicoureteric refluxes (VURs) are significantly associated with abnormal DMSA scintigraphy findings.
• Abnormal DMSA scans correlate with impaired differential renal function in children.
• Children with VURs require special consideration due to the high likelihood of abnormal DMSA findings and renal function impairment.