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Pediatric Radiology

, Volume 45, Issue 1, pp 62–68 | Cite as

Recurrent urinary tract infections in young children: role of DMSA scintigraphy in detecting vesicoureteric reflux

  • Muhammad AwaisEmail author
  • Abdul Rehman
  • Maseeh Uz Zaman
  • Naila Nadeem
Original Article

Abstract

Background

Performing micturiting cystourethrography (MCUG) in young children with recurrent urinary tract infections is controversial with discrepancy among the major guidelines.

Objective

Previous studies have shown that a normal dimercaptosuccinic acid (DMSA) scintigraphy may avoid the need of performing MCUG for detecting vesicoureteric reflux in children with first febrile urinary tract infection. However, the role of DMSA for ruling out vesicoureteric reflux in children with recurrent urinary tract infections has not been studied.

Materials and methods

Approval from institutional ethical review committee was sought and the requirement of informed consent was waived. A total of 50 children under the age of 10 years with recurrent urinary tract infections underwent MCUG scan within 3 months of DMSA scan from January 2011 to September 2012 at our institution. Diagnosis of recurrent urinary tract infections and grading of vesicoureteric reflux was according to previously established standards. Abnormalities on DMSA scan – scarring, hydronephrosis and reduced differential renal function – were compared with presence of vesicoureteric reflux on MCUG.

Results

High-grade vesicoureteric reflux was noted on MCUG in 22 (44%) cases. The findings on DMSA included hydronephrosis and scarring in 25 (50%) and 25 (50%) cases, respectively. Abnormalities on DMSA scan for detecting the presence of high-grade vesicoureteric reflux on MCUG examination had sensitivity, specificity, positive and negative predictive values of 95.45%, 35.71%, 53.85% and 90.91%, respectively. The positive and negative likelihood ratios were 1.48 and 0.13 respectively.

Conclusion

DMSA scan had high overall sensitivity and negative predictive value with a low negative likelihood ratio for ruling out high-grade vesicoureteric reflux on MCUG, which may obviate the need of invasive MCUG along with its associated drawbacks.

Keywords

Urinary tract infection Urinary tract pathology Vesicoureteric reflux Voiding cystourethrography Radionuclide imaging Dimercaptosuccinic acid scintigraphy Child 

Notes

Conflicts of interest

None

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Muhammad Awais
    • 1
    Email author
  • Abdul Rehman
    • 1
  • Maseeh Uz Zaman
    • 2
  • Naila Nadeem
    • 1
  1. 1.Department of RadiologyAga Khan University HospitalKarachiPakistan
  2. 2.Nuclear Medicine, Department of RadiologyAga Khan University HospitalKarachiPakistan

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