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Division of Nuclear Medicine, Department of Radiology; Division of Pediatric Nephrology, Department of Pediatrics; and Department of Medicine, University of Miami School of Medicine, Miami, Florida
99mTc-DMSA late static planar imaging or SPECT is being used for the investigation of focal acute pyelonephritis (APN), especially in children with urinary tract infection (UTI). Diuretic 99mTc-mercaptoacetyltriglycine (MAG3) dynamic scintirenography has been applied in the evaluation of kidney function and structure, frequently to exclude obstruction. However, in children and adults with a clinical picture of APN, diuretic MAG3 scintigraphy with zero time injection of furosemide (MAG3-F0) was observed to display focal parenchymal abnormalities; regional dysfunction (focal parenchymal decrease in early uptake; slow filling in and prolonged late retention of activity); or, less frequently, fixed defects. This observation was further studied both retrospectively and prospectively, and its sensitivity and specificity for APN were compared with those of dimercaptosuccinic acid (DMSA). Methods: In the retrospective study, for 36 children with UTI and regional parenchymal findings on MAG3-F0, data were reviewed, analyzed, and compared with the results of concurrent DMSA studies. In the prospective study, for 57 children with clinical and laboratory findings suggestive of APN, the 2 radiopharmaceuticals were used for imaging sequentially and the results of the 2 studies were compared. The criteria for abnormal findings compatible with the diagnosis of APN were, for MAG3-F0, regional parenchymal dysfunction and fixed focal defects and, for DMSA, focal defects without parenchymal loss. Results: In all groups of patients, most abnormal MAG3-F0 studies (80%) showed regional parenchymal dysfunction, but in some (20%) a fixed defect was found. Compared with DMSA and when both regional dysfunction and focal defects were considered, MAG3-F0 was as sensitive as DMSA. Some patients had only MAG3-F0 abnormalities, suggesting a slightly lower specificity for MAG3-F0 compared with DMSA (86%); this finding needs further study, because it also raises questions about the sensitivity of DMSA, considering that only a small percentage of patients with clinically suggestive findings had abnormal study findings. In most patients with fixed defects on both DMSA and MAG3-F0, follow-up studies showed no resolution, suggesting that a fixed defect on MAG3-F0 may indicate either more severe APN or preexistent scars and that regional dysfunction may be a sign more specific for APN and prognostic of potential recovery. In addition, a pattern more specific for a scar—a fixed defect with a dilated regional calyx—was seen on follow-up MAG3-F0. Conclusion: A fast (25-min) planar dynamic MAG3-F0 study was found to be as sensitive at depicting focal parenchymal abnormalities in APN as was the 3- to 4-h DMSA routine procedure. The sensitivity and specificity of both studies need further evaluation.
Key Words: acute pyelonephritis • scars • dimercaptosuccinic acid • mercaptoacetyltriglycine • furosemide renography
Received Sep. 22, 1999; revision accepted May 16, 2000.
For correspondence or reprints contact: George N. Sfakianakis, MD, Division of Nuclear Medicine (D-57), University of Miami School of Medicine, P.O. Box 016960, Miami, FL 33101.
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  A. Imperiale, C. Olianti, S. Sestini, M. Materassi, S. Daniela, R. Ienuso, and G. La Cava 123I-Hippuran Renal Scintigraphy with Evaluation of Single-Kidney Clearance for Predicting Renal Scarring After Acute Urinary Tract Infection: Comparison with 99mTc-DMSA Scanning J. Nucl. Med., November 1, 2003; 44(11): 1755 - 1760. [Abstract] [Full Text] [PDF]
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