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Imaging methods in the study of urinary tract infections in children
H N Almeida1, M Ribeiro, J Colarinha
1Nuclear Medicine Institute, Radiology Department, Santa Maria Hospital-Lisbon University.
Insights
Detecting renal scars and urinary anomalies in children with urinary tract infections (UTIs) is crucial. Renal ultrasound (US), DMSA scan, and cystogram effectively guide diagnosis and identify unsuspected renal scars.
Area of Science:
- Pediatric Nephrology
- Diagnostic Imaging
- Urology
Background:
- Urinary tract infections (UTIs) in children necessitate prompt detection of renal or urologic anomalies.
- Early diagnosis and localization of abnormalities are vital for effective management and prevention of long-term complications.
Purpose of the Study:
- To evaluate the diagnostic utility of renal and vesical ultrasound (US), DMSA scan, and cystogram in children with recurrent UTIs.
- To assess the ability of these imaging modalities to detect renal scars and urologic anomalies.
Main Methods:
- A cohort of 148 children (mean age 35.9 months) with recurrent UTIs or pyelonephritis underwent renal and vesical US, DMSA scan, and cystogram in sequence.
- Diagnostic examinations were performed at least one month after the UTI episode.
Main Results:
- 42% of children had normal findings across all three examinations; some later showed vesical dysfunction.
- Renal scars were detected by DMSA scan in 11% with normal US/cystogram, and in 57% of those with VUR.
- Vesicoureteral reflux (VUR) was present in 30%, with altered US in 50% and renal scars in 57%.
Conclusions:
- The combination of US, DMSA scan, and cystogram effectively guides the diagnostic approach for pediatric UTIs.
- The DMSA scan is particularly emphasized for its role in identifying unsuspected renal scars, crucial for long-term patient management.
Unlabelled:
When studying a child with urinary tract infection it is important to detect and localize any renal (scar) or urologic anomaly. Here we study the information obtained using: renal and vesical ultrasound (US), DMSA scan and radiologic or isotopic cystogram.
Methods:
We studied 148 children with more than one urinary infection and/or pyelonephritis; their mean age was 35.9 months (1-148 months); 55% were girls. The three diagnostic examinations--US, DMSA scan and cystogram were made in this order; the DMSA scan or cystogram was never made sooner than one month after the UTI.
Results:
In 42% of the children the three exams were normal; 4 of these children had another UTI and the urodynamic study revealed vesical disfunction. 11% had renal scars (DMSA scan) with normal US and cystogram; 30% had VUR, 50% of which had an altered US and 57% had renal scars on the DMSA scan. 12% of the children had an altered US with a cystogram showing no VUR; 66% of these had renal scars. 4% had vesical anomalies in the US and cystogram.
Conclusion:
The three exams chosen were able to direct the diagnostic approach of UTI, being sufficient in most of the cases. We would like to emphasize the importance of the DMSA scan in diagnosing unsuspected renal scars.