Hardina Septi, Nugrahadi Trias, Budiawan Hendra, Kartamihardja Achmad Hussein Sundawa
Department of Nuclear Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia.
World J Nucl Med. 2024 Jun 8;23(3):180-184. doi: 10.1055/s-0044-1787717. eCollection 2024 Sep.
Urinary tract infection (UTI) is one of the commonly encountered conditions in children. Dimercaptosuccinic acid (DMSA) scintigraphy is widely advocated for functional and morphological evaluation of the renal cortex including parenchymal defect. Moreover, only a small percentage of renal defects are detected by ultrasound. We aimed to examine DMSA scintigraphy of children and identify factors associated with cortical defect. Patients aged ≤ 18 years old who underwent DMSA scintigraphy (November 18, 2019-February 2, 2023, 30 children) were included. All children received intravenous injections of Tc-DMSA followed by static planar and single-photon-emission computed tomography imaging at 3 hours. Cortical findings and differential functions of the worst affected kidney were graded accordingly. Grade I has no more than two cortical defects, grade II has more than two cortical defects with normal parenchyma between the defects, while grade III is when generalized damage is noted, and grade IV is when a shrunken kidney is seen with no DMSA uptake. Normal functioning kidney is when the relative function at 45 to 55%, mildly reduced function at 40 to 44%, and substantially impaired function at 10 to 39%, while nonfunctioning is when the differential split renal function < 10%. All data were then statistically analyzed. Majority was female (53%). The mean age was 5.85 years. UTI episodes were 73%. Twenty-two children had congenital urinary tract anomalies. All patients with vesicoureteric refluxes (VURs) had positive defects. Scintigraphy showed abnormalities in 17 children affecting unilateral (64%) or both kidneys (36%). There were 17 children (57%) respectively in the abnormal DMSA scan findings category with normal until significant impairment of the functioning kidney category. VURs were significantly associated with abnormal scintigraphy ( < 0.05). A significant association was found between abnormal DMSA scan findings and differential renal function ( < 0.05). Significant association was noted between VURs and abnormal DMSA scintigraphy, abnormal DMSA scan findings, and impaired differential renal function. Special consideration should be given to these cases.
尿路感染（UTI）是儿童常见病症之一。二巯基丁二酸（DMSA）闪烁扫描术被广泛用于评估肾皮质的功能和形态，包括实质缺损。此外，超声仅能检测出一小部分肾缺损。我们旨在检查儿童的DMSA闪烁扫描术，并确定与皮质缺损相关的因素。
纳入了年龄≤18岁且接受DMSA闪烁扫描术的患者（2019年11月18日至2023年2月2日，共30名儿童）。所有儿童均静脉注射锝- DMSA，然后在3小时后进行静态平面和单光子发射计算机断层扫描成像。对受影响最严重肾脏的皮质表现和差异功能进行相应分级。I级为不超过两个皮质缺损，II级为超过两个皮质缺损且缺损之间的实质正常，III级为出现广泛性损伤，IV级为肾脏萎缩且无DMSA摄取。正常功能的肾脏是指相对功能在45%至55%，轻度功能降低在40%至44%，严重功能受损在10%至39%，而非功能性是指分肾功能差异＜10%。然后对所有数据进行统计分析。
大多数为女性（53%）。平均年龄为5.85岁。UTI发作占73%。22名儿童有先天性尿路异常。所有膀胱输尿管反流（VUR）患者均有阳性缺损。闪烁扫描显示17名儿童出现异常，累及单侧肾脏（64%）或双侧肾脏（36%）。在DMSA扫描结果异常类别中，分别有17名儿童（57%）的肾功能从正常直至严重受损。VUR与闪烁扫描异常显著相关（P＜0.05）。DMSA扫描结果异常与分肾功能之间存在显著关联（P＜0.05）。
VUR与DMSA闪烁扫描异常、DMSA扫描结果异常以及分肾功能受损之间存在显著关联。应对这些病例给予特别关注。
