Yen T C, Tzen K Y, Lin W Y, Chen W P, Lin C Y
Department of Nuclear Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan.
Clin Nucl Med. 1998 Dec;23(12):828-31. doi: 10.1097/00003072-199812000-00008.
This prospective study compared the value of Tc-99m DMSA renal planar scintigraphy with SPECT to detect new renal involvement in patients with repeated episodes of acute pyelonephritis (APN).
Children with suspected APN were transferred to our department for DMSA renal scans. Seventy-two children (ages 1 week to 15 years) had DMSA planar and SPECT imaging performed twice because of clinical or laboratory suspicion of repeated APN. In addition, radiographic voiding cystourethrography was also performed in all cases. The presence of vesicoureteral reflux (VUR) was graded on a scale of 0 to 5.
New lesions were observed with SPECT in 56 kidneys and with planar scintigraphy in 38 kidneys. No patients had a negative result of Tc-99m DMSA renal SPECT who also had a positive Tc-99m DMSA planar result. The degree of VUR as related to APN was diagnosed better with SPECT than with planar scintigraphy (46 compared with 30 and 10 compared with 8, respectively). There is a significant difference (P < 0.05) between the diagnostic ability of these two methods to identify the increased tendency of repeated APN to occur with high-grade VUR compared with low-grade or no VUR.
High-grade VUR is more commonly associated with renal injury than is low-grade or no VUR. If only Tc-99m DMSA renal planar scintigraphy is performed, renal scarring may be underestimated. Our results suggest that Tc-99m DMSA renal SPECT, rather than planar scintigraphy, should be used routinely in children with a clinical suspicion of APN, especially for those with scarred kidneys and high-grade VUR.
本前瞻性研究比较了锝-99m二巯基丁二酸（Tc-99m DMSA）肾平面闪烁显像与单光子发射计算机断层扫描（SPECT）在检测急性肾盂肾炎（APN）反复发作患者新出现的肾脏受累情况方面的价值。
疑似APN的儿童被转至我科进行DMSA肾扫描。72名儿童（年龄1周至15岁）因临床或实验室怀疑APN反复发作而接受了两次DMSA平面显像和SPECT显像。此外，所有病例均进行了排尿性膀胱尿道造影。膀胱输尿管反流（VUR）的程度按0至5级进行分级。
SPECT在56个肾脏中观察到新病变，平面闪烁显像在38个肾脏中观察到新病变。Tc-99m DMSA肾SPECT结果为阴性的患者，其Tc-99m DMSA平面显像结果也均为阴性。与平面闪烁显像相比，SPECT对与APN相关的VUR程度的诊断更好（分别为46例对30例和10例对8例）。在识别与高级别VUR相比低级别或无VUR时反复APN发生增加趋势的诊断能力方面，这两种方法之间存在显著差异（P<0.05）。
与低级别或无VUR相比，高级别VUR更常与肾损伤相关。如果仅进行Tc-99m DMSA肾平面闪烁显像，肾瘢痕可能会被低估。我们的结果表明，对于临床怀疑APN的儿童，尤其是那些有瘢痕肾和高级别VUR的儿童，应常规使用Tc-99m DMSA肾SPECT而非平面闪烁显像。
