The Significance of <sup>99m</sup>Technetium Dimercaptosuccinic Acid(DMSA) Scan as a Substitute for Voiding Cystourethrography(VCUG) in Evaluating Children with first Febrile Urinary Tract Infection

Han, Seung-Beom; Ko, Yong-Min; Lee, Sue-Young; Jeong, Dae-Chul; Kang, Jin-Han; Lee, Kyung-Yeon; Uhm, Mee-Ryung; Kim, Woong-Heum; Kim, Jung-Sue

doi:2007.11.2.220

J Korean Soc Pediatr Nephrol > Volume 11(2); 2007 > Article

J Korean Soc Pediatr Nephrol 2007;11(2): 220-228. doi: https://doi.org/10.3339/jkspn.2007.11.2.220

생애 첫 발열성 요로 감염 환아에 대한 평가에서 배뇨성 방광 요도 조영술을 대체하기 위한 검사로서 ^99mTechnetium dimercaptosuccinic acid(DMSA) scan의 의의

한승범, 고용민, 이수영, 정대철, 강진한, 이경연, 엄미령, 김웅흠, 김정수

¹가톨릭대학교 의과대학 소아과학교실
²가톨릭대학교 의과대학 소아과학교실
³가톨릭대학교 의과대학 소아과학교실
⁴가톨릭대학교 의과대학 소아과학교실
⁵가톨릭대학교 의과대학 소아과학교실
⁶청주성모병원 소아과학교실
⁷청주성모병원 소아과학교실
⁸청주성모병원 소아과학교실
⁹청주성모병원 소아과학교실

The Significance of ^99mTechnetium Dimercaptosuccinic Acid(DMSA) Scan as a Substitute for Voiding Cystourethrography(VCUG) in Evaluating Children with first Febrile Urinary Tract Infection

Seung-Beom Han, Yong-Min Ko, Sue-Young Lee, Dae-Chul Jeong, Jin-Han Kang, Kyung-Yeon Lee, Mee-Ryung Uhm, Woong-Heum Kim, Jung-Sue Kim

¹Department of pediatrics, College of medicine, The Catholic university of Korea
²Department of pediatrics, College of medicine, The Catholic university of Korea
³Department of pediatrics, College of medicine, The Catholic university of Korea
⁴Department of pediatrics, College of medicine, The Catholic university of Korea
⁵Department of pediatrics, College of medicine, The Catholic university of Korea
⁶Department of pediatrics, Cheongju St. Marys Hospital
⁷Department of pediatrics, Cheongju St. Marys Hospital
⁸Department of pediatrics, Cheongju St. Marys Hospital
⁹Department of pediatrics, Cheongju St. Marys Hospital

ABSTRACT

Purpose : We studied the value of clinical signs, laboratory findings and ^99mTechnetium dime-rcaptosuccinic acid(DMSA) scan in predicting the presence of vesicoureteral reflux(VUR) in children with first febrile urinary tract infection(UTI).
Methods : A retrospective analysis of 84 hospitalized children with first febrile UTI was performed. They underwent DMSA scan and voiding cystourethrography(VCUG) during the acute phase, and were divided into three groups according to the results of the VCUG: absence of VUR, mild(grade I-II) and severe VUR(grade III-V). We studied the relation of VUR to age, gender, fever duration, causative organism, white blood cell count, serum C-reactive protein and result of DMSA scan.
Results : Among 84 patients, 6 had mild and 17 had severe VUR. Thirty-eight had abnormal DMSA scan. results Patients with VUR were older than those without VUR(P<0.01). There was a lower probability of infection with Escherichia coli in patients with severe VUR than in those with mild and absent VUR(P<0.01). An abnormal DMSA scan correlated with the presence and severity of VUR(P<0.05). Severe VUR was present in 10.9% of patients with normal DMSA scan. The sensitivity, specificity, positive and negative predictive values of the DMSA scan in predicting the presence of VUR were 69.6%, 63.9%, 42.1%, and 84.8%, respectively.
Conclusion : An abnormal DMSA scan correlated to the presence and severity of VUR, but the sensitivity, specificity and positive predictive value of the DMSA scan were low. There-fore, patient with an abnormal DMSA scan requires a VCUG. In order to prevent missing the 10.9% of patients with severe VUR but normal DMSA scans, a VCUG should be performed in patient with normal DMSA scan.

Key words: Urinary tract infection | Dimercaptosuccinic acid (DMSA) scan | Vesicoureteral reflux