Özdemir Hale, Girişgen İlknur, Yaylalı Olga, Becerir Tülay, Herek Özkan, Şenol Hande, Yüksel Selçuk
Department of Pediatrics, Bingöl Genç State Hospital, Bingöl, TUR.
Department of Pediatric Nephrology, Pamukkale University Faculty of Medicine, Denizli, TUR.
Cureus. 2024 Jul 22;16(7):e65075. doi: 10.7759/cureus.65075. eCollection 2024 Jul.
Background Ureteropelvic junction stenosis (UPJS) is the most common cause of clinically significant antenatal hydronephrosis. We compared separate renal function results obtained using technetium-99m-mercaptoacetyltriglycine (Tc-99m MAG-3) and technetium-99m-dimercaptosuccinic acid (Tc-99m DMSA) in pediatric patients with UPJS to evaluate the adequacy of Tc-99m MAG-3 scintigraphy and the necessity of additional Tc-99m DMSA scintigraphy during follow-up. Methodology Patients diagnosed with hydronephrosis in the Pediatric Nephrology Department of Pamukkale University Faculty of Medicine over a period of 10 years (2012-2022) were evaluated retrospectively. Patients who had been diagnosed with UPJS and underwent both Tc-99m MAG-3 and Tc-99m DMSA scintigraphy during follow-up were included in the study. Technetium-99m-labeled MAG-3 and DMSA scans were re-evaluated for all patients by the Department of Nuclear Medicine. Results The study included 52 children with unilateral UPJS (12 girls and 40 boys) with a mean age of 6.34 ± 4.81 years (range: 2.97-9.79 years). Thirty-six patients (69.2%) were diagnosed antenatally. Differential renal function in Tc-99m DMSA was 46.94 ± 10.64 and in Tc-99m MAG-3 was 43.08 ± 11.18; the functions were lower in Tc-99m MAG-3, but the values were within normal limits for both groups (p=0.0001, z=-3.893). When differential renal functions were compared between Tc-99m DMSA and Tc-99m MAG-3 results, a statistically significant positive and strong correlation was found in the kidney with ureteropelvic junction obstruction (UPJO) (p=0.0001, r=0.752). When classifying the Tc-99m MAG-3 and Tc-99m DMSA results in the kidney with UPJO (supranormal, normal, low function) for the determination of differential renal functions, there was a consistency of 76%, and it was correlated (p=0.0001, k=0.456). While two patients had supranormal function and 13 patients had low function in Tc-99m MAG-3, five patients had supranormal function, and eight patients had low function in Tc-99m DMSA. Conclusions Some studies in the literature have reported that Tc-99m MAG-3 causes supranormal function measurements in patients with UPJS; our results showed that Tc-99m DMSA resulted in a higher rate of supranormal values for affected kidneys. We believe that Tc-99m DMSA should not be performed in addition to Tc-99m MAG-3 scintigraphy in the follow-up of every patient with UPJS but can be utilized in select cases, such as patients with surgical indications and those suspected before surgery.
背景 肾盂输尿管连接部狭窄（UPJS）是临床上导致显著产前肾积水的最常见原因。我们比较了使用锝-99m-巯基乙酰三甘氨酸（Tc-99m MAG-3）和锝-99m-二巯基丁二酸（Tc-99m DMSA）获得的小儿UPJS患者的单独肾功能结果，以评估Tc-99m MAG-3闪烁显像的充分性以及随访期间额外进行Tc-99m DMSA闪烁显像的必要性。
方法 回顾性评估在10年期间（2012 - 2022年）于帕穆卡莱大学医学院儿科肾病科被诊断为肾积水的患者。纳入在随访期间被诊断为UPJS且接受了Tc-99m MAG-3和Tc-99m DMSA闪烁显像的患者。核医学科对所有患者的锝-99m标记的MAG-3和DMSA扫描进行了重新评估。
结果 该研究纳入了52名单侧UPJS患儿（12名女孩和40名男孩），平均年龄为6.34 ± 4.81岁（范围：2.97 - 9.79岁）。36名患者（69.2%）为产前诊断。Tc-99m DMSA的分肾功能为46.94 ± 10.64，Tc-99m MAG-3的分肾功能为43.08 ± 11.18；Tc-99m MAG-3的功能较低，但两组的值均在正常范围内（p = 0.0001，z = -3.893）。当比较Tc-99m DMSA和Tc-99m MAG-3结果之间的分肾功能时，在肾盂输尿管连接部梗阻（UPJO）的肾脏中发现了具有统计学意义的正相关且相关性较强（p = 0.0001，r = 0.752）。在对UPJO肾脏（功能超常、正常、功能低下）的Tc-99m MAG-3和Tc-99m DMSA结果进行分类以确定分肾功能时，一致性为76%，且具有相关性（p = 0.0001，k = 0.456）。在Tc-99m MAG-3中，有2名患者功能超常，13名患者功能低下；在Tc-99m DMSA中，有5名患者功能超常，8名患者功能低下。
结论 文献中的一些研究报告称，Tc-99m MAG-3会导致UPJS患者的功能测量值超常；我们的结果表明，Tc-99m DMSA导致患肾超常值的发生率更高。我们认为，在对每例UPJS患者的随访中，除Tc-99m MAG-3闪烁显像外不应额外进行Tc-99m DMSA，但可用于特定病例，如具有手术指征的患者和术前疑似患者。
