Open AccessReappraisal of the effectiveness of 99m Tc‐dimercaptosuccinic acid scans for selective voiding cystourethrography in children with a first febrile urinary tract infection
Author(s) -
Shih BingFu,
Tsai JengDaw,
Tsao ChinHo,
Huang FuYuan
Publication year - 2014
Publication title -
the kaohsiung journal of medical sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.439
H-Index - 36
eISSN - 2410-8650
pISSN - 1607-551X
DOI - 10.1016/j.kjms.2014.10.005
Subject(s) - medicine , dimercaptosuccinic acid , cystourethrography , vesicoureteral reflux , urinary system , reflux , medical record , ultrasonography , gastroenterology , radiology , disease
Recent studies have yielded conflicting results regarding the ability of technetium‐99m dimercaptosuccinic acid ( 99m Tc‐DMSA) renal scans for identifying high‐grade vesicoureteral reflux (VUR) in children with a first febrile urinary tract infection (UTI). This study aimed to reevaluate the effectiveness of 99m Tc‐DMSA renal scans for selective voiding cystourethrography (VCUG) in children with a first febrile UTI. The medical records of children aged ≤ 5 years who were admitted with a first febrile UTI were retrospectively reviewed. Ultrasonography (US) and DMSA renal scans were performed within 3–5 days after admission, and VCUG was performed 7–10 days after antibiotics treatment. A total of 653 children were enrolled for analysis, including 579 patients aged < 2 years (Group A) and 74 patients aged 2–5 years (Group B). In Group A, DMSA scans were abnormal for 346 patients (59.8%), and normal for 233 patients (40.2%). High‐grade VUR was present in 99 of 346 patients (28.9%) with abnormal DMSA scans, but present in only 16 of 233 patients (6.9%) with normal DMSA scans ( p < 0.001). Regarding the prediction of high‐grade VUR, the sensitivity and negative predictive value (NPV) for the DMSA scans were 86.1% and 93.1%, respectively. In Group B, DMSA scans were abnormal for 36 patients (48.6%), and normal for 38 patients (51.4%). High‐grade VUR was present in 12 of 36 patients (33.3%) with abnormal DMSA scans, whereas none of the 38 patients with normal DMSA scans had high‐grade VUR ( p < 0.001). The sensitivity and NPV of the DMSA scans were both 100%. Using the selective VCUG strategy, approximately 40% of Group A patients and 50% of Group B patients could be spared an unnecessary VCUG, respectively. Our study results suggest that 99m Tc‐DMSA renal scans are effective in identifying children with a first febrile UTI for selective VCUG.