Utility of SPECT DMSA renal scanning in the evaluation of children with primary vesicoureteral reflux

Objectives. DMSA renal scanning is more sensitive than ultrasound in detect ing renal parenchymal scars. We proposed to determine the utility of single -photon emission computed tomography (SPECT) dimercaptosuccinic acid (DMSA) renal scanning in children with primary vesicoureteral reflux (VUR). Methods. During a 24-month period, we evaluated the charts of 368 patients who had undergone SPECT DMSA renal scanning for primary VUR. Patients were divided into three age groups: (a) less than 1 year, (b) between 1 and 5 ye ars, and (c) older than 6 years. Renal scars were deemed severe or focal, T he data were analyzed to evaluate the utility of SPECT DMSA scanning in chi ldren with primary VUR and to determine the indications for performing SPEC T DMSA. We also evaluated the sensitivity of recent renal ultrasound techno logy in detecting focal and diffuse scars. Results. One hundred twenty-eight patients were younger than 1 year at pres entation. These included 24 cases that were detected prenatally. One hundre d eighty-five were between the ages of 1 and 5 years, and 55 were 6 years o r older. Reflux nephropathy at presentation was found in 99 (26.9%) of 368 patients. DMSA scanning changed the treatment in only 13 patients (3.5%). W hen scarring was diffuse, ultrasound examination correlated 100% with DMSA scanning; when focal scarring was present, the correlation was poor. Conclusions. Our results suggest that DMSA scans should be tailored to chil dren who have ultrasound abnormalities, high-grade reflux, or recurrent bre akthrough urinary tract infections. These guidelines will result in a subst antial cost savings and a significant decrease in radiation exposure, UROLO GY 53: 1024-1028, 1999, (C) 1999, Elsevier Science Inc. All rights reserved .