Clinical Usefulness of Ultrasonography and 99mTechnetium Dimercaptosuccinic Acid Scan for Predicting the Vesicoureteral Reflux in Children with Urinary Tract Infection

Eun Mi Yang; Sang Jeong Kim; Chan Jong Kim; Young Jong Woo

doi:10.4068/cmj.2010.46.1.49

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Yang, Kim, Kim, and Woo: Clinical Usefulness of Ultrasonography and 99mTechnetium Dimercaptosuccinic Acid Scan for Predicting the Vesicoureteral Reflux in Children with Urinary Tract Infection

Original Article

Chonnam Medical Journal

Chonnam Medical Journal 2010; 46(1): 49-55.

Published online: 15 April 2010

DOI: https://doi.org/10.4068/cmj.2010.46.1.49

Clinical Usefulness of Ultrasonography and ^99mTechnetium Dimercaptosuccinic Acid Scan for Predicting the Vesicoureteral Reflux in Children with Urinary Tract Infection

Eun Mi Yang, Sang Jeong Kim, Chan Jong Kim, Young Jong Woo

Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea.

Corresponding author (cjkim@jnu.ac.kr)

Received 12 March 2010 Accepted 19 March 2010

Abstract

The purpose of this study was to evaluate the predictive value of ultrasonography (US) and ^99mtechnetium dimercaptosuccinic acid (DMSA) scan for vesicoureteral reflux (VUR) in children with urinary tract infection (UTI). This study was a retrospective review of 114 children who were diagnosed as UTI from January 2004 to December 2007. A total of 114 patients underwent a US, DMSA scan and VCUG. The patients were divided into three groups according to the results of VCUG. The findings of the US and DMSA scan were compared with VCUG results. Of the 114 patients, there were 79 (69.3%) without VUR, 12 (10.5%) with low-grade VUR (grade I, II) and 23 (20.2%) with high-grade VUR (more than grade III). The US predicted 15 of 35 VUR with a sensitivity of 42.9% and a specificity of 70.9%. A DMSA scan predicted 26 of 35 VUR with a sensitivity of 74.3%. If either the US or DMSA scan was abnormal, this condition predicted 29 of 35 VUR with a sensitivity of 82.9%, negative predictive value (NPV) of 82.9%. VUR was associated with abnormal DMSA scan findings and abnormal findings of either US or DMSA scan. If either the US or DMSA renal scan was abnormal in children with a urinary tract infection, this was predictable factor for VUR. And this condition was more accurate in high-grade VUR. As screening examination for VUR, US and DMSA scan are useful and should be performed together. If both tests are normal in children with a urinary tract infection, there may be little or no clinically significant VUR.

Keywords: Urinary tract infections, Technetium Tc 99m dimercaptosuccinic acid, Vesico-ureteral reflux, Ultrasonography

Figures and Tables

Table 1

Patients characteristics

DMSA, ^99mtechnetium dimercaptosuccinic acid; VUR, vesicoureteral reflux.

Table 2

Relationship between clinical characteristics and vesicoureteral reflux

^*Low-grade, grade I-II; ^†High-grade, grade III-V.

Table 3

Associations of each ultrasonographic finding with vesicoureteral reflux and high-grade vesicoureteral reflux

US, ultrasonography; VUR, vesicoureteral reflux; APN, acute pyelonephritis; MCDK, multicystic dysplastic kidney.

^*High-grade VUR, grade III-V.

Table 4

Associations of each ^99mtechnetium dimercaptosuccinic acid scan finding with vesicoureteral reflux and high-grade vesicoureteral reflux

DMSA, ^99mtechnetium dimercaptosuccinic acid scan; VUR, vesicoureteral reflux; APN, acute pyelonephritis; MCDK, multicystic dysplastic kidney.

^*High-grade VUR, grade III-V; ^†Odds ratio 4.70 (95% CI, 1.48~15.0).

Table 5

Usefulness of US, DMSA scan and a both test for predicting VUR

US, renal ultrasonography; DMSA scan, ^99mtechnetium dimercaptosuccinic acid scan; PPV, positive predictive value; NPV, negative predictive value; ^*Abnormal, abnormal findings on either US or DMSA scan; ^†Low-grade, grade I-II; ^‡High-grade, grade III-V.

Table 6

Relationship between abnormalities on image studies and the presence of vesicoureteral reflux

US, renal ultrasonography; DMSA, ^99mtechnetium dimercaptosuccinic acid scan.

Table 7

Usefulness of US, DMSA scan and a both-test strategy for predicting high-grade vesicoureteral reflux

US, renal ultrasonography; DMSA scan, ^99mtechnetium dimercaptosuccinic acid scan; PPV, positive predictive value; NPV, negative predictive value; ^*High-grade, grade III-V.

Table 8

Relationship between abnormalities on image studies and the presence of vesicoureteral reflux

US, renal ultrasonography; DMSA, ^99mtechnetium dimercaptosuccinic acid scan.

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