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KMID : 0880520100460010049
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Chonnam Medical Journal
2010 Volume.46 No. 1 p.49 ~ p.55
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Clinical Usefulness of Ultrasonography and 99mTechnetium Dimercaptosuccinic Acid Scan for Predicting the Vesicoureteral Reflux in Children with Urinary Tract Infection
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Yang Eun-Mi
Kim Sang-Jeong
Kim Chan-Jong
Woo Young-Jong
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Abstract
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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.
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KEYWORD
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Urinary tract infections, Technetium Tc 99m dimercaptosuccinic acid, Vesico-ureteral reflux, Ultrasonography
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