TECHNETIUM-99M-DMSA RENAL SPECT IN DIAGNOSING AND MONITORING PEDIATRIC ACUTE PYELONEPHRITIS

This study compares the sensitivity of Tc-99m-dimercaptosuccinic acid (DMSA) renal SPECT with planar scintigraphy, concluding the importance of Tc-99m-DMSA renal SPECT for the early diagnosis of acute pyeloneph ritis (APN) in patients under 3 yr of age, Methods: Twenty-seven child ren under 3 yr of age, with clinical and/or laboratory suspicion of AP N, were investigated, All Tc-99m-DMSA renal SPECT and planar images an d voiding cystoureterogram (VCUG) were obtained within 3 days of hospi talization. Results: In the first examination, renal cortical defects were detected in 23 patients (42 kidneys) with SPECT and in 9 patients (11 kidneys) with planar scintigraphy, One year after treatment, cons tant renal cortical lesions were observed in 11 patients (14 kidneys) with SPECT and 4 patients (4 kidneys) with planar scintigraphy, The hi gh grades of vesicoureteral reflux (VUR) (grade greater than or equal to 3) correlate better with APN diagnosed by SPECT (34 kidneys) than b y planar scintigraphy (8 kidneys), Multiple renal cortical defects (nu mber of lesions greater than or equal to 4) were only seen in patients under 1.5 yr old and none of those with a negative Tc-99m-DMSA renal SPECT had a positive Tc-99m-DMSA renal planar scintigraphy at any time , There is a significant difference (p < 0.05) between the diagnostic ability of these two methods of examination, Conclusion: Our results s uggest that (TC)-T-99m-DMSA renal SPECT should be used, where possible , instead of planar DMSA in routine examination of children with clini cal suspicion of APN, especially for those under 3 yr of age.