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Imaging of pyelonephritis

M P Lavocat1, D Granjon, D Allard

  • 1Department of Pediatrics, CHU de Saint Etienne, Hôpital Nord, F-42055 Saint Etienne Cedex, France.

Pediatric Radiology
|February 1, 1997
PubMed
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Technetium-99m dimercaptosuccinic acid (DMSA) scans are the most sensitive imaging technique for detecting acute pyelonephritis and subsequent renal scarring in children. DMSA scans are superior to ultrasonography and computed tomography for diagnosis and follow-up.

Area of Science:

  • Pediatric Nephrology
  • Diagnostic Imaging
  • Infectious Diseases

Background:

  • Accurate diagnosis of pyelonephritis in children is challenging using clinical and laboratory markers alone.
  • Renal involvement and scarring can lead to long-term complications if not promptly identified.

Purpose of the Study:

  • To compare the diagnostic value of renal sonography, 99mTc DMSA scintigraphy, and CT in detecting renal involvement during acute urinary tract infections (UTIs) in children.
  • To assess the sensitivity of DMSA scans for identifying permanent renal scars 6 months post-infection.

Main Methods:

  • Prospective study of 55 children with febrile UTIs.
  • All children underwent ultrasonography (US), DMSA scanning, and micturating cystourethrography.
  • 18 children also underwent computed tomography (CT).

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  • A second DMSA scan was performed on 48 children after a mean of 7.5 months.

    • Main Results:

    • US showed abnormalities in 45% of children; DMSA scans indicated pyelonephritis in 93%.
    • CT revealed abnormalities in 14 of 18 patients; DMSA was more sensitive for renal involvement.
    • Initial DMSA scans showed parenchymal defects correlating with vesicoureteral reflux, but not always with severe clinical symptoms.
    • Follow-up DMSA scans indicated resolution, improvement, persistence, or deterioration of renal abnormalities.

    Conclusions:

    • 99mTc DMSA scintigraphy is the reference standard for detecting and monitoring renal scarring in pediatric UTIs due to its high sensitivity.
    • DMSA scans are more sensitive than US and CT for assessing renal involvement.
    • CT is less suitable due to radiation exposure and the need for sedation.