1st Pediatric Department, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece.
World J Pediatr. 2012 Feb;8(1):52-6. doi: 10.1007/s12519-012-0335-7. Epub 2012 Jan 27.
99mTc-dimercaptosuccinic acid (DMSA) scan is the golden standard for the diagnosis of acute pyelonephritis and renal scaring. We investigated the use of acute phase DMSA scan in infants presented promptly to the hospital because of the first episode of their febrile urinary tract infection (UTI).
Ninety-eight infants with microbiologically confirmed first episode of febrile UTI were studied. DMSA scans were carried out within 7 days in these infants after admission. Infants with an abnormal acute DMSA scan underwent a second DMSA scan 6-12 months later.
Overall, acute DMSA scan was abnormal in 16 (16.3%) of the 98 patients. There were no differences in sex, age, fever over 38.5°C, blood inflammation indices, or evidence of vesicoureteral reflux (VUR) between patients with normal and abnormal acute DMSA scan (P>0.05). However, infants with grade III to V VUR as well as those with delayed treatment presented significantly increased renal involvement by acute DMSA scan (P<0.05). The sensitivity and specificity of abnormal acute DMSA scan to predict grade III to V VUR were 50% and 88% respectively. Its positive and negative likelihood ratios were 4.16 and 0.57, respectively. Of 16 children with abnormal initial DMSA scan results, 14 underwent a second DMSA scan. Follow-up DMSA scans were normal in 12 of the 14 children.
Parenchymal damage found in a minority of infants with febrile UTI presented promptly to the hospital. Acute phase DMSA scan should be carried out only in selected patients. An abnormal acute DMSA scan is a moderate predictor for dilated VUR and its ability to exclude VUR is restricted.
99mTc-二巯丁二酸（DMSA）扫描是诊断急性肾盂肾炎和肾瘢痕的金标准。我们研究了在因首次发热性尿路感染（UTI）而迅速就诊的婴儿中使用急性期 DMSA 扫描的情况。
对 98 例经微生物学证实的首次发热性 UTI 婴儿进行了研究。这些婴儿入院后 7 天内进行 DMSA 扫描。急性 DMSA 扫描异常的婴儿在 6-12 个月后进行第二次 DMSA 扫描。
总体而言，98 例患者中 16 例（16.3%）急性 DMSA 扫描异常。急性 DMSA 扫描正常和异常的患者在性别、年龄、体温超过 38.5°C、血液炎症指标或膀胱输尿管反流（VUR）证据方面无差异（P>0.05）。然而，存在 III 至 V 级 VUR 的婴儿以及治疗延迟的婴儿的急性 DMSA 扫描肾受累明显增加（P<0.05）。异常急性 DMSA 扫描预测 III 至 V 级 VUR 的敏感性和特异性分别为 50%和 88%。其阳性和阴性似然比分别为 4.16 和 0.57。在 16 例初始 DMSA 扫描结果异常的儿童中，有 14 例进行了第二次 DMSA 扫描。14 例儿童中有 12 例随访 DMSA 扫描正常。
少数迅速就诊的发热性 UTI 婴儿中发现了实质损伤。仅应在选择的患者中进行急性期 DMSA 扫描。异常的急性 DMSA 扫描是扩张性 VUR 的中度预测指标，其排除 VUR 的能力受到限制。
