All issues > Volume 53(3); 2010

Original Article

Korean J Pediatr. 2010;53(3):408-413. Published online March 15, 2010.

Limitations of 99mTc-DMSA scan in diagnosing acute pyelonephritis in children

Byung Gee BG Kim¹, Jae Ryoung JR Kwak¹, Ji Min JM Park¹, Ki Soo KS Pai¹

¹Department of pediatrics, Ajou University School of Medicine, Suwon, Korea

Correspondence Ki Soo KS Pai ,Email: kisoopai@ajou.ac.kr

Received: September 15, 2009; Revised: October 30, 2009   Accepted: December 14, 2009.

Abstract

Purpose
: We aimed to prove the relative limitation of 99mTc-DMSA scintigraphy (DMSA) compared to computed tomography (CT) in diagnosing acute pyelonephritis (APN) in children.
Methods
: Since September 2006, after a 64-channel CT was imported, 10 DMSA false-negative patients have been identified: these patients underwent a CT scan for acute abdomen or acute febrile symptoms and were diagnosed as having APN; however, their DMSA scans were clear. We focused on these 10 DMSA false-negative patients and analyzed their clinical findings and CT results. We used Philips Brilliance Power 64-channel CT scanner for the CT scan and Siemens Orbitor Nuclear Camera 60 Hz for the DMSA scan.
Results
The 10 DMSA false-negative patients were mostly males (80%) and infants (80%). They had fever for a mean of 1.1-day duration before admission and showed increase in acute reactants: leukocyte, erythrocyte sedimentation rate, and C-reactive protein. The CT findings of renal lesions were focal in 6 (60%) cases and diffuse in 4 (40%) cases, and most of the lesions were unilateral in 80% of patients. CT proved that 22 renal lesions were neglected by DMSA. Differential renal function test by DMSA was also of no use in the evaluation of renal lesions.
Conclusion
In this study, DMSA scan showed limitation in finding renal cortical lesions of CT-proven APN patients. DMSA false-negative results seem to occur at early-phase disease of infantile age, but more prospective studies are needed to determine the reasons and their prevalence.

Keywords :Acute pyelonephritis, 64-Channel computed tomography, 99mTc-DMSA scintigraphy, Children, Infancy