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Hypertension in paediatrics: can pre- and post-captopril technetium-99m dimercaptosuccinic acid renal scans exclude
I Minty1, M F Lythgoe, I Gordon
1Department of Radiology, Hospital for Sick Children, London, UK.
Insights
Renal disease is a common cause of hypertension in children. A new imaging technique using technetium-99m dimercaptosuccinic acid (DMSA) scans with captopril may help diagnose renovascular disease with less radiation exposure.
Area of Science:
- Pediatric Nephrology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Renal disease is the leading cause of hypertension in children over one year of age.
- Arteriography, the gold standard for diagnosing renovascular disease, is invasive and involves significant radiation exposure for pediatric patients.
- Non-invasive imaging modalities with reduced radiation burden are needed for pediatric hypertension evaluation.
Purpose of the Study:
- To evaluate the diagnostic utility of pre- and post-captopril technetium-99m dimercaptosuccinic acid (99mTc-DMSA) imaging compared to arteriography in children with hypertension.
- To determine if combined 99mTc-DMSA imaging enhances the diagnosis of renovascular disease.
- To assess the feasibility of using low-radiation screening investigations for pediatric renovascular hypertension.
Main Methods:
- Retrospective analysis of 18 children (ages 3-17 years) with hypertension.
- Comparison of arteriography findings with pre- and post-captopril 99mTc-DMSA imaging results.
- Evaluation of 99mTc-DMSA scan sensitivity and specificity for renal parenchymal and renovascular disease.
Main Results:
- 99mTc-DMSA scans are sensitive indicators of renal parenchymal disease but lack specificity.
- The combination of pre- and post-captopril 99mTc-DMSA studies showed potential to increase sensitivity and specificity for renovascular disease diagnosis.
- This imaging approach offers a low radiation burden screening method for pediatric hypertension.
Conclusions:
- Pre- and post-captopril 99mTc-DMSA imaging may serve as a valuable, low-radiation screening tool for renovascular hypertension in children.
- Positive screening results warrant a high index of suspicion for renovascular disease as the cause of hypertension.
- This method can be implemented in most institutions, guiding further diagnostic workup.
Abstract:
In children over 1 year of age, renal disease is the commonest cause of hypertension. Arteriography is considered the reference method to establish the diagnosis of renovascular disease; however, it is an invasive technique with a high radiation burden for children. This was a retrospective study of pre- and post-capto-technetium-99m dimercaptosuccinic acid (DMSA) imaging compared with arteriography in 18 children between the ages of 3 and 17 years. Alone, the 99mTc-DMSA scan is a sensitive indicator of renal parenchymal disease, although non-specific in suggesting the pathology. The combination of pre- and post-captopril studies may increase the sensitivity and specificity in the diagnosis of renovascular disease in the presence of hypertension. This work suggests that a screening investigation with a low radiation burden can be carried out at most institutions; if the investigation is positive, there will be a high index of suspicion that renovascular disease is the cause of the hypertension.