Current trends in acquisition and timinig of renal cortical scintigraphy in children with acute pyelonephritis
Abstract
Renal cortical scintigraphy is a simple noninvasive method based on principle of uptake 99mTc-DMSA in functional renal parenchyma. Static imaging is performed 2-4 hours after intravenous injection.
Examination is standardize, well available, reproducible and it does not need sedation. It is associated with radiation dose of approximately 1 mSv, regardless of the age of the child.
The sensitivity of DMSA scan for the detection of parenchymal defects due to infections ranges from 90 to 100% but does not allow differentiation of acute pyelonephritis from renal scars. It is the reference method for detecting renal sequelae after acute pyelonephritis, is more sensitive than sonography and should be performed no sooner than 6 months after the last documented infection.
This indication is widely accepted. The role of cortical scintigraphy is still largely debated in acute pyelonephritis.
Some authors suggest that after a normal result of an acute DMSA scan micturating cystourethrography is unnecessary. In children with a clinical diagnosis of pyelonephritis the optimal management strategy to identify associated renal injury and to uncover risk factors for future infection does not exist.
Each of them has advantages and disadvantages and without their knowledge is impossible to practise them.