Diagnosing Acute Pyelonephritis with CT,^99mTc-DMSA SPECT, and Doppler Ultrasound: A Comparative Study

Abstract

PurposeWith growing interest in early imaging, the aim of our study was to define the most practical modality for routine clinical use for the diagnosis of acute pyelonephritis (APN). We compared the sensitivity of enhanced computerized tomography (CT), dimercaptosuccinic acid (DMSA) scintigraphy, and Doppler ultrasonography (DUS) by using clinical findings as the standard of reference.Materials and MethodsA total of 207 APN patients (191 women, 16 men; mean age, 49.4 years; range, 17-88 years) were enrolled in this study. All the patients underwent imaging modalities during hospitalization. SPECT images were obtained 4 hours after injection of 99mTc-DMSA. Transverse and coronary CT images were obtained before and after injection of the contrast agent. DUS was performed in the longitudinal, transverse, and coronal planes. All the images were read independently by a single radiologist and a nuclear medicine specialist. The sensitivity of each modality for detecting APN was compared.ResultsCT showed significantly superior sensitivity compared with that of DUS (81.0% vs. 33.3%, respectively, n=147). DMSA scintigraphy also showed significantly superior sensitivity compared with that of DUS (74.7% vs. 33.3%, respectively, n=150). Compared with DMSA scintigraphy, CT showed superior sensitivity, but the difference was not statistically significant (81.0% vs. 74.8%, respectively, n=147, p=0.163).ConclusionsFor cases of clinically suspected APN, CT and DMSA scintigraphy appear to be equally sensitive and reliable for detecting APN, although CT is more practical in various fields. DUS was significantly less sensitive.

Acute Flank Pain: Multi-detector Computed Tomographic Evaluation in the Emergency Room

“…Shen and Brown stated that early imaging is cost-effective and advocate imaging in people who are going to be hospitalized by APN (14,15). Yoo et al (14) reported that there are clinically significant findings in 16% of the patients. MDCT is important for the detection of abscess and APN.…”

Radiologinių Tyrimų Reikšmė Diagnozuojant Pielonefritą

“…Kairysis inkstas padidėjęs su aplink pastebima skysčio sankaupa, viršutiniame poliuje hiperintensinė, neaiškių ribų zona; MRT T2 vaizdai scintigrafija negali atskirti ūminio pažeidimo nuo esančių randinių pakitimų, teigiami radiniai nebūtinai rodo ūmi-nį pielonefritą, galutinę diagnozę galima nustatyti tik po 6 mėnesių stebėjimo. Jie padarė išvadą, kad šiuo metu KT yra tinkamiausias tyrimas kasdienėje klinikinėje praktikoje diagnozuojant ūminį pielonefritą [13]. 6 pav.…”

Ultrasound Assessment of Postpartum Fever

“…Contrast-enhanced CT is the imaging study of choice for detection of acute pyelonephritis, and has a greater sensitivity as compared to ultrasound. 17 Common CT findings are poorly defined wedge-shaped lesions that have decreased attenuation. Often this radiates from the papilla in the medulla to the cortical surface.…”

“…Also, bands of hyperattenuation and hypoattenuation oriented in parallel of the tubules and collecting ducts can be seen. 17 Treatment of pyelonephritis includes initial empirical therapy, which should be started while awaiting a urine culture and susceptibility test and should be tailored based on the microorganism. 18 In general, oral ciprofloxacin 500 mg twice daily for 7 days is the choice of antibiotic for patients not requiring hospitalization.…”