Power Doppler ultrasonography in the diagnosis of acute childhood pyelonephritis

Abstract

In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis (APN) is a challenge, particularly during infancy. In an attempt to differentiate APN from lower urinary tract infection (UTI), we evaluated the ability of power Doppler ultrasonography (PDU) to predict renal parenchymal involvement, as assessed by dimercaptosuccinic acid ((99m )Tc-DMSA) scintigraphy. The study comprised 62 patients, 46 girls and 16 boys, aged 2 weeks to 5 years, admitted to the pediatric department with febrile UTI. All children were examined by PDU and DMSA scintigraphy within the first 3 days of admission. In the group of 31 patients with one or more DMSA scan abnormalities, the PDU showed a matching perfusion defect in 27 (87%). Of 26 children with normal DMSA scintigraphy, the PDU evaluation was also normal in 24. The sensitivity and specificity of PDU for the detection of affected kidneys were 87% and 92.3%, and the positive predictive value and negative predictive value were 93.1% and 85.7%, respectively. These data indicate the PDU has a high sensitivity and specificity for differentiating APN from lower UTI and may be a useful and practical tool for the diagnosis of APN in infants and children.

The role of tissue harmonic imaging ultrasound combined with power Doppler ultrasound in the diagnosis of childhood febrile urinary tract infections

“…Another observation of us was that most of the false negative results of our patients were related with the left kidney. As emphasized in other studies, this can be explained with affection of the image quality of the blood flow in the upper pole of the left kidney because of lack of hepatic acoustic window of the left kidney (10,16,19).…”

“…Eggli et al (18) were the first investigators who showed that the sensitivity of USG in detecting inflammation in renal perenchyma increased from 38% to 63% with As a result, they found the sensitivity and specificity values to be 92.1% and 93.8% for DMSA, 86.8% and 87.5% for CT, 89.50% and 87.5% for magnetic resonance imaging (MRI) and 74.3% and 56,7% for PDUS. After this study, more satisfactory results were published both for adult and pediatric patient groups (4,5,7,10). In fact, a marked advancement occured in the USG technology after the first studies which evaluated the success of this method and the sensitivity has been reported to be 74-89% in recent studies (19,20).…”

“…Currently, Tc-99m dimercaptosuccinicacid (DMSA) is considered the gold standard imaging method in detecting renal parenchymal involvement in patients diagnosed with APN (7)(8)(9). This investigation method has negative aspects including exposure to radiation, need for intravenous access and high cost (10). Conventional urinary sysem ultrasonography (USG) is still accepted as the first-line imaging method in all children below the age of 2 years who have first febrile UTI and all children with recurrent febrile UTI (11).…”

Value of comprehensive renal ultrasound in children with acute urinary tract infection for assessment of renal involvement: comparison with DMSA scintigraphy and final diagnosis

“…Multiple experimental and clinical studies compared the ability of different imaging modalities to diagnose upper UTI in the pediatric population [1,2,4,15,16,25]. Renal involvement and scarring has a multifactorial pathophysiology.…”

“…However, early detection of renal involvement is essential for intensity and duration of treatment, as acute pyelonephritis (aPN) may result in irreversible renal damage. APN can induce renal scars as a complication; the importance of aPN-associated risks is under debate, but long-term complications such as hypertension and chronic renal failure have to be considered [2]. Therefore, an early, reliable, and accurate as well as easily accessible imaging method for aPN assessment may be valuable [3].…”