Sukamoto E, Itoh K, Morita K, Katoh C, Nakada K, Nonomura K, Kakizaki H, Koyanagi T, Tamaki N
Department of Nuclear Medicine, Hokkaido University School of Medicine,Sapporo, Japan.
Ann Nucl Med. 1999 Dec;13(6):401-6. doi: 10.1007/BF03164934.
We reviewed Tc-99m DMSA scintigraphy in children with vesicoureteral reflux (VUR) in order to assess whether repeated Tc-99m DMSA scans are necessary for the follow up of these patients. Ninety-seven children who were followed up for more than one year (1-7.4 years, average 2.8 years) after the first DMSA scan were included in the study. Fifty-one patients had been diagnosed as primary VUR and 46 as secondary VUR. Age at the first examination ranged from 0 to 14 years (average 5.1 years). Planar images were taken 2 hours after injection. The % renal uptake per injected dose (%RU) was calculated from posterior images. Kidneys in 11 patients (11.3%) changed morphologically during the follow up. Of these, new photon deficient areas (PD) were detected in only 4 patients (4.1%). All of these 4 patients had neurogenic bladder and were managed with self-catheterization. Of the remaining 7 patients, cortical thinning progressed in 5 patients (5.2%) and PDs resolved in 3 patients (3.1%). In one of these 7 patients, PD resolved in one kidney and cortical thinning progressed in the contralateral kidney. Of 97 patients reviewed, % RU decreased more than 20% during the follow up in 6 patients (6.2%). All were diagnosed as secondary VUR due to neurogenic bladder. %RU decreased only in the contracted kidneys at the initial scan. Two of them underwent renal transplantation because of severe renal failure. In conclusion, new PD rarely developed and % RU decreased in only a few patients during the follow up of children with VUR. Repeated Tc-99m DMSA scintigraphy therefore seems to have little benefit in the follow up of children with VUR. It should be performed in selected patients with high risk of urinary tract infection or renal failure.
我们回顾了99m锝二巯基丁二酸（Tc-99m DMSA）闪烁扫描在膀胱输尿管反流（VUR）患儿中的应用情况，以评估对这些患者进行随访时重复进行99m锝二巯基丁二酸扫描是否必要。本研究纳入了97例在首次DMSA扫描后随访超过1年（1 - 7.4年，平均2.8年）的儿童。51例患者被诊断为原发性VUR，46例为继发性VUR。首次检查时的年龄范围为0至14岁（平均5.1岁）。注射后2小时采集平面图像。根据后位图像计算每注射剂量的肾脏摄取百分比（%RU）。11例患者（11.3%）的肾脏在随访期间出现形态改变。其中，仅4例患者（4.1%）检测到新的光子缺乏区（PD）。这4例患者均患有神经源性膀胱，并接受了自我导尿治疗。其余7例患者中，5例（5.2%）出现皮质变薄，3例（3.1%）的PD消失。在这7例患者中的1例，一侧肾脏的PD消失，而对侧肾脏出现皮质变薄。在97例接受回顾的患者中，6例（6.2%）在随访期间%RU下降超过20%。所有这些患者均因神经源性膀胱被诊断为继发性VUR。%RU仅在初始扫描时收缩的肾脏中下降。其中2例因严重肾衰竭接受了肾移植。总之，在VUR患儿的随访中，新的PD很少出现，只有少数患者的%RU下降。因此，重复进行99m锝二巯基丁二酸闪烁扫描对VUR患儿的随访似乎益处不大。应仅在有尿路感染或肾衰竭高风险的特定患者中进行。
