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Intra- and interobserver variability in interpretation of DMSA scans using a set of standardized criteria

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Abstract

A set of criteria was developed to standardize assessment of DMSA renal scintigraphy which were performed to evaluate children for acute pyelonephritis and renal scarring. This study was undertaken to assess intra- and interobserver variability in the interpretation of DMSA renal scintigraphy using these criteria. Renal contours and parenchyma were assessed in three zones. Contours were assessed as normal or abnormal and parenchymal defects were evaluated in terms of character, shape and degree in three regions (upper and lower pole and midzone). Two nuclear medicine physicians blindly reviewed 57 DMSA scintigraphy on two occasions each. Disagreement of each observer's evaluation of the same scintigraphy on two different occasions was described as intraobserver variability, and the comparison between readings by each of the two observers was described as interobserver variability. High levels of intra-(95.9% and 90.6% respectively,p<0.05) and interobserver agreement (84.4%,p<0.05) were demonstrated. There were minor differences in inconsistencies between the two kidneys or different kidney zones. We conclude that standardization of criteria resulted in higher intra- and interobserver consistency in interpretation of DMSA scintigraphy.

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References

  1. Winberg J (1987) Clinical aspects of urinary tract infection. Chapter 36. In: Holliday MA, Banat TM, Vernier RL (eds) Pediatric nephrology. Williams and Williams Baltimore

    Google Scholar 

  2. Marild S, Hellstrom M, Jodal U, Svanborg Eden C (1989) Fever, bacteriuria and concomitant disease in children with urinary tract infection. Pediatr Infect Dis J 8:36

    PubMed  Google Scholar 

  3. Fairley KF, Carson NE, Gutch RC et al. (1971) Site of infection in acute urinary tract infection in general practice. Lancet II:615

    Google Scholar 

  4. Eykyn S, Lloyd-Davies RW, Shuttleworth KED, Vinnicombe J (1972) The localization of urinary tract infection by ureteric catheterization. Invest Urol 9:271

    PubMed  Google Scholar 

  5. Whitaker J, Hewstone AS (1969) The bacteriologic differentiation between upper and lower urinary tract infection in children. J Pediatr 74:364

    PubMed  Google Scholar 

  6. Harrison RB, Shaffer HA (1979) The roentgenographic findings in acute pyelonephritis. JAMA 241:1718

    PubMed  Google Scholar 

  7. June CH, Browning MD, Smith CP et al. (1985) Ultrasonography and computed tomography in severe urinary tract infection. Arch Intern Med 145:841–845

    PubMed  Google Scholar 

  8. Traisman ES, Conway JJ, Traisman HS et al (1986) The localization of urinary tract infection with 99mTc glucoheptonate scintigraphy. Pediatr Radiol 16:403

    PubMed  Google Scholar 

  9. Verber IG, Strudley MR, Meller ST (1988) 99Tc dimercaptosuccinic acid (DMSA) scan as first investigation of urinary tract infection. Arch Dis Child 63:1320

    PubMed  Google Scholar 

  10. Bjorgvinsson E, Majd M, Eggli KD (1991) Diagnosis of acute pyelonephritis in children: comparison of sonography and Tc99m DMSA scintigraphy. Am J Roentgenol 157:539

    Google Scholar 

  11. Rushton HG, Majd M, Vim D (1988) Evaluation of99Technetium-dimercaptosuccinic acid renal scans in experimental acute pyelonephritis in piglets. J Urol 140:1169

    PubMed  Google Scholar 

  12. Arnold AJ, Brownless SM, Carty HM, Rickwood AMK (1990) Detection of renal scarring by DMSA scanning — an experimental study. J Pediatr Surg 25:391

    PubMed  Google Scholar 

  13. Rushton HG, Majd M, Jantausch B, Wiedermann BL, Belman AB (1992) Renal scarring following reflux and nonreflux pyelonephritis in children: evaluation with99technetium-dimercaptosuccinic acid scintigraphy. J Urol 147:1327

    PubMed  Google Scholar 

  14. Jakobsson B, Nolstedt L, Svensson L, Soderlundh S, Berg U (1992)99mTechnetium-dimercaptosuccinic acid scan in the diagnosis of acute pyelonephritis in children: relation to clinical and radiological findings. Pediatr Nephrol 6:328

    PubMed  Google Scholar 

  15. Majd M, Rushton HG (1992) Renal cortical scintigraphy in the diagnosis of acute pyelonephritis. Semin Nucl Med 22:98

    PubMed  Google Scholar 

  16. Conway JJ (1988) The role of scintigraphy in urinary tract infection. Semin Nucl Med 18:308

    PubMed  Google Scholar 

  17. Handmaker H (1982) Nuclear renal imaging in acute pyelonephritis. Semin Nucl Med 12:246

    PubMed  Google Scholar 

  18. Sty JR, Wells RG, Starshak RJ, Schroeder BA (1980) Imaging in acute renal infection in children. Am J Roentgenol 148:471

    Google Scholar 

  19. Pylkkanen J, Vislka J, Koskimies O (1981) The value of diagnosis of childhood urinary tract infection in predicting renal injury. Acta Paediatr Scand 70:879

    PubMed  Google Scholar 

  20. Goldraich NP, Ramos OL, Goldraich IH (1989) Urography versus DMSA scan in children with vesicoureteric reflux. Pediatr Nephrol 3:1

    PubMed  Google Scholar 

  21. Little PJ, McPherson DR, DeWardener HE (1965) The appearence of the intravenous pyelogram during and after pyelonephritis. Lancet I:1186

    Google Scholar 

  22. Shaw P, Whitear P, Gordon I (1987)Comparison of DMSA scans and IVU's. Pediatr Radiol 17:341 (abstr)

    Google Scholar 

  23. Dinkel E, Orth S, Dittrich M, Schulte-Wisserman H (1986) Renal sonography in the differentiation of upper from lower urinary tract infection. AJR 146:775

    PubMed  Google Scholar 

  24. Kahn PC (1979) Renal imaging with radionuclides, ultrasound and computed tomography. Semin Nucl Med 9:43

    PubMed  Google Scholar 

  25. Andrich MP, Majd M (1992) Diagnostic imaging in the evaluation of the first urinary tract infection in infants and young children. Pediatrics 90:436

    PubMed  Google Scholar 

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Patel, K., Charron, M., Hoberman, A. et al. Intra- and interobserver variability in interpretation of DMSA scans using a set of standardized criteria. Pediatr Radiol 23, 506–509 (1993). https://doi.org/10.1007/BF02012131

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  • DOI: https://doi.org/10.1007/BF02012131

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