Consensus on renal cortical scintigraphy in children with urinary tract infection

A questionnaire related to cortical scintigraphy in children with urinary t ract infection was submitted to 30 experts. A wide consensus was reached on several issues related to planar images: Tc-99m dimercapto succinic acid ( DMSA) appears as the most appropriate tracer for renal imaging; dynamic tra cers are considered to be inferior, in particular 99mTc diethylenetriaminep entaacetate, which is not recommended. The general opinion is that DMSA sci ntigraphy is not feasible with a minimal dose below 15 MBq, whereas the max imum dose should not be higher than 110 MBq. The dose schedule generally is based on body surface area, and sedation is only exceptionally given to ch ildren. Images are obtained 2 to 3 hours after injection, preferably with h igh resolution collimators; pinhole images are used by only half of the exp erts. Posterior and posterior oblique views are used by most of the experts , and the posterior view is acquired in supine positions. At least 200.000 kcounts or 5 minute acquisition is required for nonzoomed images. As a qual ity control, experts check the presence of blurred or double outlines on th e DMSA images. Color images are not used and experts report on film or dire ctly on the computer screen. As far as normal DMSA images are concerned, mo st experts agree on several normal variants. Hydronephrosis is not a contra indication for DMSA scintigraphy but constitutes a pitfall. Differential re nal function generally is measured, but no consensus is reached whether or not background should be subtracted. Mast of the experts consider 45% as th e lowest normal value. A consensus is reached on some scintigraphic aspects that are likely to improve and on some others that probably represent pers istent sequelae, There is a wide consensus for the systematic use of DMSA s cintigraphy for detection of renal sequelae, whereas only 58% of the expert s are systematically performing this examination during the acute phase of infection. Copyright (C) 1999 by W.B. Saunders Company.