Sensitivity of ultrasonography in detecting renal parenchymal defects: 6 years’ follow-up

Levart, Tanja Kersnik; Ključevšek, Damjana; Kenig, Anton; Kenda, Rajko B.

doi:10.1007/s00467-008-1099-0

Cited by 9 publications

(4 citation statements)

References 30 publications

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“…DMSA is the gold standard for assesing renal parenchymal defects, but it is the second choice due to radiation exposure and cost. 6,7 Renal defects located centrally over the pelvicalyceal system were considered normal. There could also be ambiguous cases of renal atrophy with hydronephrosis, leading to normal reports.…”

Section: Discussionmentioning

confidence: 99%

Renal Cortical Imaging with Tc-99m DMSA in Children: An Institutional Review

Hardina,

Nugrahadi,

Budiawan

et al. 2024

World J Nucl Med

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Background Urinary tract infection (UTI) is one of the commonly encountered conditions in children. Dimercaptosuccinic acid (DMSA) scintigraphy is widely advocated for functional and morphological evaluation of the renal cortex including parenchymal defect. Moreover, only a small percentage of renal defects are detected by ultrasound. We aimed to examine DMSA scintigraphy of children and identify factors associated with cortical defect. Methods Patients aged ≤ 18 years old who underwent DMSA scintigraphy (November 18, 2019–February 2, 2023, 30 children) were included. All children received intravenous injections of 99mTc-DMSA followed by static planar and single-photon-emission computed tomography imaging at 3 hours. Cortical findings and differential functions of the worst affected kidney were graded accordingly. Grade I has no more than two cortical defects, grade II has more than two cortical defects with normal parenchyma between the defects, while grade III is when generalized damage is noted, and grade IV is when a shrunken kidney is seen with no DMSA uptake. Normal functioning kidney is when the relative function at 45 to 55%, mildly reduced function at 40 to 44%, and substantially impaired function at 10 to 39%, while nonfunctioning is when the differential split renal function < 10%. All data were then statistically analyzed. Results Majority was female (53%). The mean age was 5.85 years. UTI episodes were 73%. Twenty-two children had congenital urinary tract anomalies. All patients with vesicoureteric refluxes (VURs) had positive defects. Scintigraphy showed abnormalities in 17 children affecting unilateral (64%) or both kidneys (36%). There were 17 children (57%) respectively in the abnormal DMSA scan findings category with normal until significant impairment of the functioning kidney category. VURs were significantly associated with abnormal scintigraphy (p < 0.05). A significant association was found between abnormal DMSA scan findings and differential renal function (p < 0.05). Conclusion Significant association was noted between VURs and abnormal DMSA scintigraphy, abnormal DMSA scan findings, and impaired differential renal function. Special consideration should be given to these cases.

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Section: Discussionmentioning

confidence: 99%

Renal Cortical Imaging with Tc-99m DMSA in Children: An Institutional Review

Hardina,

Nugrahadi,

Budiawan

et al. 2024

World J Nucl Med

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“…Systematic approaches to analyze DMSA scan and define renal scarring with US have been proposed, but they are not systematically used in clinic. [10][11][12] Additionally, Levart et al [8][9] concluded twice that US was sensitive enough to identify clinically significant scars. In their studies, US detected all severe renal parenchymal defects (5/5, 100%) seen on DMSA, with a lower sensitivity to detect moderate (19/24, 79.2%) and mild (15/44, 31.8%) defects.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, we relied on available radiologist reports, even if our pediatric urologists are used to reviewing US images. 5,7,9,12 According to Barry et al, US could achieve excellent sensitivity and specificity to detect renal scars by dedicated pediatric radiologists using state-of-the-art equipment. 12 Unfortunately, these circumstances did not reproduce the daily clinical scenario.…”

Section: Detecting Renal Anomalies In Childrenmentioning

confidence: 99%

“…Recent advances in ultrasound (US) technology have led some physicians to believe that US study could now be more appropriate to evaluate renal defects. [6][7][8][9] The constant improvement of imaging instruments, the increasing knowledge of users, and the increased awareness of the ALARA principle in urology made us reappraise our current practice. As more recent US equipment was purchased at our tertiary pediatric centre, we sought to evaluate whether we could solely rely on US compared to DMSA scintigraphy to assess renal parenchymal anomalies.…”

Section: Introductionmentioning

confidence: 99%

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Dimercaptosuccinic acid scintigraphy vs. ultrasound for renal parenchymal defects in children

Marceau-Grimard

Marion

Côté

et al. 2017

CUAJ

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Introduction: Dimercaptosuccinic acid (DMSA) scintigraphy is the gold standard in the evaluation of renal parenchymal defects and is widely used in the pediatric population. As more recent ultrasound equipment was purchased at our tertiary pediatric centre, our objective was to evaluate if renal ultrasound (US) results are equivalent or sufficient when compared to DMSA scintigraphy in the assessment of renal anomalies. Methods: The charts of all 463 patients who underwent DMSA scintigraphy between January 2009 and May 2014 at our pediatric tertiary centre were reviewed. The objective was to look for correlation between US and DMSA scan results for renal scars/dysplasia. A hundred and sixty pediatric patients followed with US and DMSA scan for a total of 285 renal units remained for evaluation after exclusions. Timing of the exams, urinary tract infection (UTI), and indication for imaging were reviewed. Results with older (105 patients) and newer (55 patients) US equipment were compared. Results: Among the 285 renal units evaluated, 39 (14%) had renal parenchymal defects shown by US and 87 (31%) by DMSA scintigraphy (sensitivity 36%, specificity 96%). The DMSA scan was normal for eight abnormal kidneys (3%) on US. The results were not statistically significant when compared to exams performed with newer or older US machines. Conclusions: At our institution, US data are not sensitive enough to give reliable information about renal parenchymal defects, even with newer equipment. DMSA scintigraphy still remains mandatory for the evaluation of renal anomalies, but could be optional if the US exam indicates parenchymal defects.

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Urinary Tract Infections in Children: Recommendations for Antibiotic Prophylaxis and Evaluation. An Evidence-Based Approach

et al. 2010

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Urinary tract infections (UTIs) are common in children, but the routine work-up and treatment recommendations are still controversial. Long-term complications, including renal scarring, hypertension, and renal failure, have been the main concern and the reason for use of antibiotic prophylaxis and invasive imaging techniques. In the past several years, numerous studies have been published comparing different imaging protocols and questioning the use of antibiotic prophylaxis. The latest guidelines from the United Kingdom, published in 2007, recommend more selective approach based on evidence. In this review, we critically appraise the literature published in the past 5 years. The risk of developing long-term complications after a UTI is extremely low, and the evidence suggests selective imaging to a select group of children at risk. Finding those at risk for long-term complications is yet to be determined.

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Sensitivity of ultrasonography in detecting renal parenchymal defects: 6 years’ follow-up

Cited by 9 publications

References 30 publications

Renal Cortical Imaging with Tc-99m DMSA in Children: An Institutional Review

Renal Cortical Imaging with Tc-99m DMSA in Children: An Institutional Review

Dimercaptosuccinic acid scintigraphy vs. ultrasound for renal parenchymal defects in children

Urinary Tract Infections in Children: Recommendations for Antibiotic Prophylaxis and Evaluation. An Evidence-Based Approach

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