RT Journal Article
SR Electronic
T1 <sup>123</sup>I-Hippuran Renal Scintigraphy with Evaluation of Single-Kidney Clearance for Predicting Renal Scarring After Acute Urinary Tract Infection: Comparison with <sup>99m</sup>Tc-DMSA Scanning
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1755
OP 1760
VO 44
IS 11
A1 Imperiale, Alessio
A1 Olianti, Catia
A1 Sestini, Stelvio
A1 Materassi, Marco
A1 Daniela, Seracini
A1 Ienuso, Rita
A1 La Cava, Giuseppe
YR 2003
UL http://jnm.snmjournals.org/content/44/11/1755.abstract
AB The value of 123I-hippuran (OIH) renal sequential scintigraphy (RSS) in predicting the evolution of defects detected by 99mTc-dimercaptosuccinic acid (DMSA) scanning during a first episode of acute pyelonephritis (APN) was assessed. Methods: Fifty-eight children with APN underwent 99mTc-DMSA planar scanning and 123I-OIH RSS during acute infection and at least 5 mo later. Renal lesions found by 99mTc-DMSA scanning were classified according to the following 99mTc-DMSA grading system: 0 = normal, 1 = 1 lesion, 2 = 2 lesions, and 3 = diffuse damage with renal parenchymal subversion. Renal scarring was diagnosed whenever a renal cortical defect detected at the first 99mTc-DMSA examination persisted on the follow-up 99mTc-DMSA examination. Single-kidney clearance rate (Cl) was evaluated by a method that was previously validated at our institution and is based on time–activity curves measured on the heart and kidney areas by the region-of-interest technique. Results: 99mTc-DMSA scanning showed renal damage in 76 kidneys and had negative findings for the remaining 40 kidneys (2 patients had bilaterally negative findings). 99mTc-DMSA scanning determined 40 kidneys to be grade 0, 49 to be grade 1, 21 to be grade 2, and 6 to be grade 3. For 99mTc-DMSA grades of 0–3, the corresponding Cl mean values (in mL/min/1.73 m2 of body surface area [BSA]) were 292 ± 33, 237 ± 39, 210 ± 54, and 140 ± 53, respectively. The Spearman regression coefficient (R) demonstrated a significant correlation between 99mTc-DMSA grade and Cl (R = 0.69, P &lt; 0.0001). Thirty-six of the lesions detected by staging 99mTc-DMSA were shown to have recovered on follow-up renal scans, whereas 40 developed scars. A significant difference in Cl was found between the 2 groups (P &lt; 0.0002). The Cl cutoff value was determined by univariate discriminant analysis; a Cl value of 232 mL/min/1.73 m2 of BSA discriminated best between scarred and nonscarred kidneys, with a specificity, sensitivity, positive predictive value, negative predictive value, and overall accuracy of 95%, 95%, 90%, 97%, and 95%, respectively. Conclusion: Cl evaluation, in the course of acute urinary tract infection, is highly valuable in predicting the fibrotic evolution of renal damage detected on acute 99mTc-DMSA scanning. Also, our data show close agreement between Cl and the grade determined by staging 99mTc-DMSA.