TY - JOUR
T1 - Recurrent urinary tract infections in young children
T2 - role of DMSA scintigraphy in detecting vesicoureteric reflux
AU - Awais, Muhammad
AU - Rehman, Abdul
AU - Zaman, Maseeh Uz
AU - Nadeem, Naila
N1 - Publisher Copyright:
© 2014, Springer-Verlag Berlin Heidelberg.
PY - 2014/1
Y1 - 2014/1
N2 - Background: Performing micturiting cystourethrography (MCUG) in young children with recurrent urinary tract infections is controversial with discrepancy among the major guidelines.Objective: Previous studies have shown that a normal dimercaptosuccinic acid (DMSA) scintigraphy may avoid the need of performing MCUG for detecting vesicoureteric reflux in children with first febrile urinary tract infection. However, the role of DMSA for ruling out vesicoureteric reflux in children with recurrent urinary tract infections has not been studied.Materials and methods: Approval from institutional ethical review committee was sought and the requirement of informed consent was waived. A total of 50 children under the age of 10 years with recurrent urinary tract infections underwent MCUG scan within 3 months of DMSA scan from January 2011 to September 2012 at our institution. Diagnosis of recurrent urinary tract infections and grading of vesicoureteric reflux was according to previously established standards. Abnormalities on DMSA scan – scarring, hydronephrosis and reduced differential renal function – were compared with presence of vesicoureteric reflux on MCUG.Results: High-grade vesicoureteric reflux was noted on MCUG in 22 (44%) cases. The findings on DMSA included hydronephrosis and scarring in 25 (50%) and 25 (50%) cases, respectively. Abnormalities on DMSA scan for detecting the presence of high-grade vesicoureteric reflux on MCUG examination had sensitivity, specificity, positive and negative predictive values of 95.45%, 35.71%, 53.85% and 90.91%, respectively. The positive and negative likelihood ratios were 1.48 and 0.13 respectively.Conclusion: DMSA scan had high overall sensitivity and negative predictive value with a low negative likelihood ratio for ruling out high-grade vesicoureteric reflux on MCUG, which may obviate the need of invasive MCUG along with its associated drawbacks.
AB - Background: Performing micturiting cystourethrography (MCUG) in young children with recurrent urinary tract infections is controversial with discrepancy among the major guidelines.Objective: Previous studies have shown that a normal dimercaptosuccinic acid (DMSA) scintigraphy may avoid the need of performing MCUG for detecting vesicoureteric reflux in children with first febrile urinary tract infection. However, the role of DMSA for ruling out vesicoureteric reflux in children with recurrent urinary tract infections has not been studied.Materials and methods: Approval from institutional ethical review committee was sought and the requirement of informed consent was waived. A total of 50 children under the age of 10 years with recurrent urinary tract infections underwent MCUG scan within 3 months of DMSA scan from January 2011 to September 2012 at our institution. Diagnosis of recurrent urinary tract infections and grading of vesicoureteric reflux was according to previously established standards. Abnormalities on DMSA scan – scarring, hydronephrosis and reduced differential renal function – were compared with presence of vesicoureteric reflux on MCUG.Results: High-grade vesicoureteric reflux was noted on MCUG in 22 (44%) cases. The findings on DMSA included hydronephrosis and scarring in 25 (50%) and 25 (50%) cases, respectively. Abnormalities on DMSA scan for detecting the presence of high-grade vesicoureteric reflux on MCUG examination had sensitivity, specificity, positive and negative predictive values of 95.45%, 35.71%, 53.85% and 90.91%, respectively. The positive and negative likelihood ratios were 1.48 and 0.13 respectively.Conclusion: DMSA scan had high overall sensitivity and negative predictive value with a low negative likelihood ratio for ruling out high-grade vesicoureteric reflux on MCUG, which may obviate the need of invasive MCUG along with its associated drawbacks.
KW - Child
KW - Dimercaptosuccinic acid scintigraphy
KW - Radionuclide imaging
KW - Urinary tract infection
KW - Urinary tract pathology
KW - Vesicoureteric reflux
KW - Voiding cystourethrography
UR - http://www.scopus.com/inward/record.url?scp=84937148143&partnerID=8YFLogxK
U2 - 10.1007/s00247-014-3062-5
DO - 10.1007/s00247-014-3062-5
M3 - Article
C2 - 24993242
AN - SCOPUS:84937148143
SN - 0301-0449
VL - 45
SP - 62
EP - 68
JO - Pediatric Radiology
JF - Pediatric Radiology
IS - 1
ER -