Whitear P, Shaw P, Gordon I
Department of Radiology, Hospital for Sick Children, London.
Br J Radiol. 1990 Jun;63(750):438-43. doi: 10.1259/0007-1285-63-750-438.
A retrospective comparison of 99Tcm dimercaptosuccinic acid (DMSA) scans and intravenous urograms (IVUs) was performed on a large, unselected paediatric population to assess critically the relative merits of these two techniques. A total of 205 children were studied, providing 388 kidneys for comparison. The studies agreed in 81%, both being normal in 39%, and both abnormal in 42%. In 28 kidneys (7%), the IVU was abnormal when the 99Tcm DMSA was normal. There was a collecting system abnormality in 27 kidneys, but 10 kidneys also showed a parenchymal abnormality. In all these the parenchymal abnormality was global thinning on the IVU, and the contralateral kidney was small. In 40 kidneys (10%) the 99Tcm DMSA was abnormal when the IVU was normal: the abnormalities demonstrated were predominantly focal defects. After excluding IVUs of poor diagnostic quality, only 14 kidneys (3.6%) showed this disparity. The important clinical subgroups are infection, with or without reflux (27 kidneys), hypertension (4) and neonates with poor renal function (2). The one false positive 99Tcm DMSA was a result of an anatomical variant. Global thinning in a "normal" kidney on a 99Tcm DMSA scan may be overlooked when the contralateral kidney is poorly functioning and small.
对一大群未经筛选的儿科患者进行了锝-99m二巯基丁二酸（DMSA）扫描与静脉肾盂造影（IVU）的回顾性比较，以严格评估这两种技术的相对优点。共研究了205名儿童，提供了388个肾脏用于比较。两项检查结果一致的占81%，两者均正常的占39%，两者均异常的占42%。在28个肾脏（7%）中，锝-99m DMSA扫描正常时IVU异常。27个肾脏存在集合系统异常，但10个肾脏也显示实质异常。在所有这些病例中，IVU上的实质异常为整体变薄，对侧肾脏较小。在40个肾脏（10%）中，IVU正常时锝-99m DMSA扫描异常：显示的异常主要为局灶性缺损。排除诊断质量差的IVU后，只有14个肾脏（3.6%）出现这种差异。重要的临床亚组包括有或无反流的感染（27个肾脏）、高血压（4个）和肾功能差的新生儿（2个）。锝-99m DMSA的一例假阳性是解剖变异的结果。当对侧肾脏功能差且体积小时，锝-99m DMSA扫描中“正常”肾脏的整体变薄可能被忽视。
