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KMID : 0616619980040010157
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Journal of Soonchunhyang Medical College
1998 Volume.4 No. 1 p.157 ~ p.165
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The Usefulness of Color doppler sonography of Acute Pyelonephritis in Children
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홍현숙/Hong, Hyun-Sook
이혜경/권귀향/취득린/김은미/Lee, Hae-Kyung/Kwon, Kui-Hyang/Choi, Deuk-Lin/Kim, Eun-Mi
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Abstract
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Purpose : Urinary tract infections are common in childhood and are most frequent in those under 1 year of age. In these children, however, differentiation of the pyelonephritis from cystitis is clinically difficult. We investigated the utility of color doppler image ultrasound in the diagnosis of acute pyelonephritis(APN) in children. Results were compared with renal cortical scintigraphy using ´-rc- DMSA.
Materials and Methods : 99mTc-DMSA SPECT and color doppler ultrasound were performed within 1 week intervals in 14 patients with clinically suspected APN. (aged 4months to 15years: mean 6.1 year, 7girls and 7boys). Urine culture was considered positive if greater than 100.000 colonied of a single organsim were isolated. CDI was performed with 3.5MHz convex linear probe Ultramark 9(ATL, Bothell, Washington, USA) following a standard gray scale sonogram of the kidneys. Renal cortical scintigraphy was performed with 99mTc DMSA SPECT(PRISM 2000, Picker, USA). Axial, coronal, both sagittal pinhole images were obtained 15-2 hour after 1mCi isotope was injected. Renal scan was considered to be abnormal and indicative of APN when there was a focal, wedged shaped defect in radionuclide accumulation extending from the periphery of the kidney to centrally or if there was diffuse abnormality in renal tubular function. Renal scarring was defined when defects were shallow lesions along the periphery of the kidney with evidence of volume loss, or if they could be shown from prior examination to pre-date of the acute episode.
The color doppler image were interpreted to be consistent with APN if there was decreased flogs in the renal cortex .
Results: Of the 28 kidneys were examined, renal scan showed 5 cases of abnormal findings, 3 cases were APN, 2 cases were chronic scarring. Two of the three cases of APN showed decreased blood flow on CDI and positive culture, for a sensitivy 67%. Two cases of renal scarring due to grade V bilateral vesicoureteral reflux show decreased blood flow at right upper pole kidney on CDI, however DMSA scan had difficulties finding the new lesion due to underlying irregularity of scarred kidney. Color doppler US correctly identified 4 of 5 renal poles with APN and 21 of 23 with no APN including 2 patients with false positive. The DMSA scan was used as the standard of comparison in the study; the CDI has a sensitivity 67%, specificity 84%, positive predictive value 33%, negative predictive value 95916.
Conclusion: The DMSA scan was used as a standard of comparison, CDI has a sensitivity 67%, specificity 84%. The lesion showed decreased blood flow and on one follow up case increased blood flow. The presence of prior renal scarring made interpretation of asymmetric vascularity difficult on DMSA, the use of CDI may increase the diagnostic sensitivity of sonography in pediatric pyelonephritis.
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KEYWORD
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