Open Access, Peer-reviewed
pISSN 2233-7385
eISSN 2233-7393
    Chonnam Med J. 2010 Apr;46(1):49-55. Korean.
    Published online Apr 15, 2010.
    https://doi.org/10.4068/cmj.2010.46.1.49
    Copyright © 2010 Chonnam National University Medical School
    Original Article

    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, and Young Jong Woo
      • Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea.
    • Corresponding author (Email: cjkim@jnu.ac.kr )
    Received March 12, 2010; Accepted March 19, 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

    Tables

    Table 1
    Patients characteristics

    Table 2
    Relationship between clinical characteristics and vesicoureteral reflux

    Table 3
    Associations of each ultrasonographic finding with vesicoureteral reflux and high-grade vesicoureteral reflux

    Table 4
    Associations of each 99mtechnetium dimercaptosuccinic acid scan finding with vesicoureteral reflux and high-grade vesicoureteral reflux

    Table 5
    Usefulness of US, DMSA scan and a both test for predicting VUR

    Table 6
    Relationship between abnormalities on image studies and the presence of vesicoureteral reflux

    Table 7
    Usefulness of US, DMSA scan and a both-test strategy for predicting high-grade vesicoureteral reflux

    Table 8
    Relationship between abnormalities on image studies and the presence of vesicoureteral reflux

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    MeSH Terms
    Child
    Humans
    Mass Screening
    Retrospective Studies
    Sensitivity and Specificity
    Succimer
    Technetium Tc 99m Dimercaptosuccinic Acid
    Urinary Tract
    Urinary Tract Infections
    Vesico-Ureteral Reflux
    Metrics
    Share
    Tables
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