TY - JOUR T1 - Comparison of direct radionuclide cystography (DRCG) and micturating cystourethrogram (MCU) in detecting VUR in patients with urinary tract infections JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 354P LP - 354P VL - 47 IS - suppl 1 AU - Parul Thakral AU - Rakesh Kumar AU - Grupad Bandopadhayaya AU - Arun Malhotra Y1 - 2006/05/01 UR - http://jnm.snmjournals.org/content/47/suppl_1/354P.2.abstract N2 - 1380 Objectives: Childhood urinary tract infection (UTI) with vesicoureteric reflux (VUR) may predispose to renal scarring and end stage renal disease. Micturating cystourethrography (MCU) is the primary investigation of choice to detect VUR. Direct radionuclide cystography (DRCG) is utilized in the follow-up evaluation of children diagnosed with VUR. However, MCU and DRCG both require catheterization, which children do not tolerate well. To compare the DRCG by direct supra-pubic puncture (SDRC) and micturating cystourethrogram (MCU) studies in detecting VUR. In addition, we determined the incidence of renal scarring in children of UTI with VUR. Methods: This prospective study involves 44 children (88 renal units) aged between 3-14 years (mean age 6.13 years) with confirmed UTI based on urine culture. There were 26 boys and 18 girls. All these children underwent DRCG, MCU and Tc99m -dimercaptosuccinic acid (DMSA) scan with in a period of 2-weeks of each other. DRCG was done by direct supra-pubic puncture (SDRC) and instillation of the radiotracer into the bladder, avoiding catheterization. Results: DRCG detected VUR in 59/88 (67%) renal units, while, MCU was positive in 57/88 (64%) renal units. There were 56 concordant and 4 discordant results between DRCG and MCU for detection VUR. Three renal units, which showed reflux in DRCG, did not show any reflux in MCU. However, there was only one renal unit in which MCU showed reflux while DCG was normal. In addition, one renal unit showed grade 1 reflux in MCU whereas it was severe reflux in DRCG. Tc99m-DMSA revealed renal scarring in 58/88 (66%) renal units. The children with VUR had renal scarring in 46/58 (79.3%) renal units, while scarring was found in 12/30 (40%) renal units, which had no reflux. There was a significant difference in renal scarring in children with and with out VUR. It was also noted that there was an exponential increase in scarring with severity of VUR. Conclusions: The supra-pubic direct radionuclide cystography is more sensitive technique than MCU for detecting as well as grading VUR. There is a cause-and-effect relationship between VUR and renal scarring, and the incidence of scarring almost doubles with VUR. ER -