Childhood acute pyelonephritis: comparison of power Doppler sonography and Tc-DMSA scintigraphy

Tc 99m DMSA scintigraphy is regarded as the gold standard for the detection and localization of acute pyelonephritis (APN) in children. Power Doppler sonography (PD US) is a radiation-free and cost-effective technique that could be useful in the diagnosis of APN in children. To compare the predictiv...

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Bibliographic Details
Published in:Pediatric radiology 2007-07, Vol.37 (7), p.685-690
Main Authors: Stogianni, Aggeliki, Nikolopoulos, Panagiotis, Oikonomou, Ippoliti, Gatzola, Magdalini, Balaris, Vassilios, Farmakiotis, Dimitrios, Dimitriadis, Athanasios
Format: Article
Language:English
Subjects:
Acute Disease
Adolescent
Child
Child, Preschool
Female
Humans
Infant
Infant, Newborn
Male
Predictive Value of Tests
Pyelonephritis - diagnostic imaging
Radionuclide Imaging
Radiopharmaceuticals
Sensitivity and Specificity
Technetium Tc 99m Dimercaptosuccinic Acid
Ultrasonography, Doppler
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Summary:Tc 99m DMSA scintigraphy is regarded as the gold standard for the detection and localization of acute pyelonephritis (APN) in children. Power Doppler sonography (PD US) is a radiation-free and cost-effective technique that could be useful in the diagnosis of APN in children. To compare the predictive value of PD US with DMSA scintigraphy in the diagnosis of APN in children. A total of 74 neonates and children with clinical findings consistent with possible upper urinary tract infection were evaluated with PD US and DMSA scintigraphy. Children with anatomic (grey-scale) abnormalities were excluded. A total of 147 kidneys were examined within the first 48 h after the onset of symptoms. Each kidney was divided into three zones (upper, middle, and lower third). APN was diagnosed by PD US in 46 kidneys. Sensitivity and specificity for detecting APN using DMSA scintigraphy as the reference standard were 73.8% and 85.7%, respectively. There was good agreement between PD US and DMSA scintigraphy in the localization of lesions. In clinically suspected APN, PD US has acceptable specificity and sensitivity, if performed within the first 48 h and could be helpful in neonates and children under 3 months of age in whom the use of scintigraphy is generally discouraged.
ISSN:0301-0449
1432-1998
DOI:10.1007/s00247-007-0510-5