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Does DMSA Renal Scintigraphy Add to Renal Ultrasonography in the Evaluation and Management of Children with Vesicoureteral Reflux?
Heather N. Di Carlo, M.D., Adam J. M. Kern, M.D., Angela D. Gupta, M.D., Bhavik B. Shah, M.D., Eric Z. Massanyi, M.D., Ming-Hsien Wang, M.D..
Johns Hopkins School of Medicine, Baltimore, MD, USA.

BACKGROUND:
Debate exists over the utilization of dimercaptosuccinic acid (DMSA) renal scintigraphy in the evaluation and management of children with vesicoureteral reflux (VUR). The authors conducted a single institutional study of children presenting for evaluation of VUR and sought to identify the utility of DMSA renal scintigraphy in their management strategies.
METHODS:
An IRB approved retrospective review was performed on all children at the authors’ institution with voiding cystourethrogram (VCUG) confirmed VUR between 2006 and 2012, who also underwent DMSA renal scintigraphy to assess renal function. Renal ultrasound and DMSA renal scan results were examined for evidence of urological abnormalities and renal scarring, and correlated with ultimate necessity for an anti-reflux procedure.
RESULTS:
One hundred twenty-six patients with VUR and who underwent both renal ultrasound as well as DMSA imaging were identified. Using DMSA as the gold standard, the sensitivity of renal ultrasound at picking up scarring in these patients was only 34% (table 1). Twenty-nine patients (23%) were found to have renal scarring on DMSA scan, with initial renal ultrasound being normal in only 10 of these patients (34%). Twenty-one out of 29 (72%) patients ultimately required an anti-reflux procedure, of which 11 (52%) had scarring noted on DMSA. Two of these 11 patients (18%) had a normal renal ultrasound. Fifteen of the 21 patients requiring surgical intervention presented with history of a documented febrile urinary tract infection.
CONCLUSIONS:
DMSA renal scintigraphy aids in the evaluation of the child with VUR by unveiling renal parenchymal scarring not seen on renal ultrasound. Further prospective studies evaluating long-term outcomes in this patient population with parenchymal scarring are necessary to further delineate the impact of nuclear renal imaging on ultimate renal function.
Sensitivity and Specificity of Renal Ultrasound at Diagnosing Renal Scarring
Renal ScarringRenal Scarring AbsentTotal
Normal renal ultrasonography105060
Abnormal renal ultrasonography193352
Total2983
Sensitivity0.3348PPV0.1667
Specificity0.3976NPV0.6346


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