Chroustová Daniela, Palyzová Daniela, Urbanová Irena, Kolská Monika
Department of Nuclear Medicine, University Hospital Královské Vinohrady and 3rd School of Medicine, Charles University, Prague, Czech Republic.
Nucl Med Rev Cent East Eur. 2006;9(1):46-50.
Renal scintigraphy, generally using 99mTc-DMSA, is the accepted reference standard for detection of renal cortical changes. The timing of the test, i.e., whether an acute 99mTc-DMSA scan, a follow-up only or both scans should be performed, however, remains open to discussion. In our study, a six-month follow- up DMSA scan was performed in all the children diagnosed with a first attack of acute pyelonephritis (APN) in two large paediatric clinics of Charles University's 3rd School of Medicine in Prague during a five-year period. All diagnoses were confirmed by a paediatric nephrologist.
382 children (267 girls, 115 boys) aged between 7 months and 19 years were included in the study. For analytical purposes, the patients were divided into 4 age groups: I--less than 1 year of age, II--1-5 years, III--5-10 years, and IV--10-19 years. In all children younger than five years, a micturition cystourethrogram (MCUG) for detection of vesicoureteric reflux (VUR) was performed between one and three months after the APN episode. Static renal scintigraphy, using an HR collimator with parallel holes was performed using a planar Gamma camera MB 9200 (Gamma Budapest) in all children six months after APN, with a complement of pinhole images, SPECT or PSPECT of the kidneys.
APN occurred most frequently in group II (62.3%, or 238 children) and ranged between 10-15% in the remaining groups. APN was found very frequently in boys less than one year old and showed a marked decrease with increasing age. Among girls, however, APN incidence was observed to increase with age. Pathological renal changes were present in children with, as well as without, VUR. The incidence of pathological DMSA findings six months after APN was relatively low (44/382 patients, or 11.5%). Regular monitoring of these children is very important for detection of renal scarring.
肾闪烁扫描术，通常使用99m锝 - 二巯基丁二酸（99mTc - DMSA），是检测肾皮质变化公认的参考标准。然而，该检查的时机，即是否应进行急性99mTc - DMSA扫描、仅进行随访扫描还是两者都进行，仍有待讨论。在我们的研究中，对布拉格查理大学第三医学院的两家大型儿科诊所中在五年期间被诊断为首次急性肾盂肾炎（APN）发作的所有儿童进行了为期六个月的随访DMSA扫描。所有诊断均由儿科肾病专家确认。
本研究纳入了382名年龄在7个月至19岁之间的儿童（267名女孩，115名男孩）。为便于分析，将患者分为4个年龄组：I组——小于1岁，II组——1 - 5岁，III组——5 - 10岁，IV组——10 - 19岁。在所有五岁以下的儿童中，在APN发作后1至3个月内进行排尿性膀胱尿道造影（MCUG）以检测膀胱输尿管反流（VUR）。在APN发作六个月后，使用平面伽马相机MB 9200（Gamma Budapest）对所有儿童进行静态肾闪烁扫描，使用带有平行孔的高分辨率准直器，并辅以肾脏的针孔图像、单光子发射计算机断层扫描（SPECT）或正电子发射断层扫描（PSPECT）。
一、在I组中，MCUG上VUR阳性的所有4名儿童DMSA扫描均异常，而VUR阴性的32名患者中只有2名DMSA扫描异常。二、在II组中，17名儿童MCUG上有VUR，其中6名DMSA扫描异常，11名正常。221名无VUR的儿童中大多数DMSA闪烁扫描正常；仅17名儿童有异常发现。三、在III组中，所有有VUR的儿童DMSA扫描均异常，但无VUR的53名儿童中只有5名DMSA扫描异常。四、IV组50名儿童中有5名DMSA扫描异常。
APN在II组中最常见（62.3%，即238名儿童），其余组在10% - 15%之间。一岁以下男孩中APN非常常见，且随年龄增长显著下降。然而，在女孩中，APN发病率随年龄增加。有或无VUR的儿童均存在病理性肾脏改变。APN发作六个月后病理性DMSA检查结果的发生率相对较低（44/382例患者，即11.5%）。定期监测这些儿童对于检测肾瘢痕形成非常重要。
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