Comparison of DMSA Scintigraphy with Intravenous Urography for the Detection of Renal Scarring and its Correlation with Vesicoureteric Reflux

Abstract

A series of 208 patients was prospectively assessed for reflux nephropathy by intravenous urography (IVU) and 99mTc-dimercaptosuccinate (DMSA) scintigraphy. All patients were studied at least 3 months after their most recent urinary tract infection and micturating cystourethrography (MCU) was performed prior to the scintigraphic studies. DMSA scintigraphy detected significantly more cortical abnormalities than did IVU. There was also a correlation between cortical abnormalities in the DMSA studies and the degree of reflux on MCU. The validity of DMSA as a cortical imaging agent is evaluated and the histological evidence for its efficacy derived from the animal model is reviewed, lending weight to its establishment as the "gold standard" for renal cortical scarring.

Vesicoureteric Reflux: The Evolution of the Understanding of the Anatomy and the Development of Radiology

“…Similar results have been obtained from pig studies by Risdon et al [55]and Arnold et al [56]. The clinical studies supporting the accuracy of the DMSA for scars include those by Webb and Britton [57]and Elison et al [58]; the latter group conducted a prospective study of 208 patients which showed more anomalies on DMSA than on IVP, with good correlation of the DMSA findings with the degree of VUR. Monsour et al [59]assessed 150 children with IVP, ultrasound, and DMSA, finding 1.92 ± 1.92 scars on intravenous urogram, 2.79 ± 1.87 scars on ultrasound, and 3.82 ± 1.71 scars on the DMSA; these authors suggested an eight-part grading system for the renal scarring based on the DMSA appearance.…”

Clinical effectiveness and cost-effectiveness of tests for the diagnosis and investigation of urinary tract infection in children: a systematic review and economic model

“…218 Half of these studies did not include an appropriate spectrum of patients. The quality of reporting was poor: the majority of studies (6/8) did not report patient selection criteria; 133,138,141,193,196,214 five studies provided inadequate description of the reference standard and/or the index test; 133,193,196,217,218 half of all studies did not report sufficient information to assess the avoidance of test review bias, 133,141,196,214 and four studies did not report sufficient information to assess avoidance of disease progression bias. 133,214,217,218 Disease progression bias was a problem in two studies 141,196 and partial verification bias in another study.…”

“…Only half of the studies included an appropriate patient spectrum 133,193,196,214 and only two provided sufficient details on selection criteria. 217,218 Half of the studies reported that both test review bias and reference standard review bias had been avoided, 138,193,217,218 but only one study reported that the same clinical information was available when test results were interpreted as would be available in practice. 217 None of the studies provided an explanation as to why some of the children did not receive both the index test and reference standard.…”

“…The data estimated by renal unit were used as these were deemed more pertinent to the question of detection of renal scarring, and this was the method of reporting in the majority of studies in this category. 138 Two further studies reported data for more than one scintigraphic technique. 133,218 Data from these studies for In general, sensitivity and specificity values reported in these studies were high.…”

“…Seven studies evaluated 99m Tc-DMSA, 133,138,141,193,196,214,217 and one study evaluated 123 I-hippuran. 218 Half of these studies did not include an appropriate spectrum of patients.…”