Renal pathology and the 99mTc-DMSA image during the evolution of the early pyelonephritic scar: an experimental study

This study describes the pathologic changes underlying the appearances of the 99mTc-DMSA renal image during acute pyelonephritis induced in piglets by a combination of vesicoureteral reflux (VUR) and urinary infection. In a total of 42 animals examined, pathologic lesions were identified in 36 of the 46 kidneys subjected to VUR and urinary infection, but no lesions developed in the remaining 10 refluxing kidneys. While scintigraphic defects were invariably associated with pyelonephritic lesions (specificity 100%), some small lesions were not identified (sensitivity 80%). There was a significant association (p = < 0.001) between the degree of photon deficiency seen scintigraphically and the histologic changes (early and late lesions). However, the scintigraphic appearance of individual lesions was also influenced by factors such as their extent and density, so that consideration of the macroscopic characteristics was also important for precise correlation.