Veenboer Paul W, Hobbelink Monique G G, Ruud Bosch J L H, Dik Pieter, van Asbeck Floris W A, Beek Frederik J A, de Kort Laetitia M O
Department of Urology, University Medical Center Utrecht, Utrecht, The Netherlands.
Division of Image, Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Neurourol Urodyn. 2015 Aug;34(6):513-8. doi: 10.1002/nau.22608. Epub 2014 Apr 7.
To study additional benefits of performing Tc-99m dimercaptosuccinic acid (Tc-99m-DMSA) scintigraphy as part of the follow-up of adults with spinal dysraphism (SD), compared with ultrasonography, with regard to finding renal scarring and difference in split renal function.
Between January 2011 and April 2013 every patient visiting our specialized outpatient clinic for adults with SD was invited to undergo both renal ultrasonography and Tc-99m-DMSA scintigraphy. Outcomes of both modalities were compared, with focus on renal scarring. The relation between renal scarring and hypertension was also assessed.
In total, 122 patients (with 242 renal units) underwent both renal scintigraphy and ultrasonography. More scars were seen on DMSA scintigraphy than on ultrasonography: 45.9% vs. 10.3% of renal units; P < 0.001. Renal scarring seen on DMSA was associated with the presence of hypertension (P = 0.049) whereas scarring seen on ultrasonography was not (P = 0.10). If ultrasonography was difficult to interpret, many more scars were missed on ultrasonography (78.9%) compared with easily interpretable ultrasonographic images (30.6%; P < 0.001).
In adults with SD, ultrasonography is of value to diagnose dilatation and stones of the upper urinary tract; however, compared with DMSA renography, renal scars are often missed, especially when the ultrasound is difficult to interpret.
研究锝-99m二巯基丁二酸（Tc-99m-DMSA）闪烁扫描术作为脊髓脊膜膨出（SD）成人患者随访检查一部分的额外益处，与超声检查相比，在发现肾瘢痕形成及分肾功能差异方面的情况。
2011年1月至2013年4月期间，邀请每一位到我们成人SD专科门诊就诊的患者接受肾脏超声检查和Tc-99m-DMSA闪烁扫描术。比较两种检查方式的结果，重点关注肾瘢痕形成情况。还评估了肾瘢痕形成与高血压之间的关系。
共有122例患者（242个肾单位）接受了肾脏闪烁扫描术和超声检查。DMSA闪烁扫描术发现的瘢痕比超声检查更多：肾单位的比例分别为45.9%和10.3%；P<0.001。DMSA上发现的肾瘢痕形成与高血压的存在相关（P=0.049），而超声检查发现的瘢痕则不然（P=0.10）。如果超声检查难以解读，与易于解读的超声图像相比，超声检查漏诊的瘢痕更多（78.9%对30.6%；P<0.001）。
在SD成人患者中，超声检查对上尿路扩张和结石的诊断有价值；然而，与DMSA肾图相比，肾瘢痕常常被漏诊，尤其是当超声难以解读时。
