Comparison of 99mTc- Ethylene Dicysteine and 99mTc-Dimercaptosuccinic Acid Scintigraphy for the Evaluation of Cortical Scarring and Differential Renal Function in Children with Recurrent Urinary Tract Infection
Citation Information :
Rao K, Mittal B, Raja S, Pareek V, Singh B. Comparison of 99mTc- Ethylene Dicysteine and 99mTc-Dimercaptosuccinic Acid Scintigraphy for the Evaluation of Cortical Scarring and Differential Renal Function in Children with Recurrent Urinary Tract Infection. J Postgrad Med Edu Res 2012; 46 (4):183-186.
Urinary tract infection (UTI) is the most common and severe bacterial infection in children. Renal scarring and associated deterioration in the differential renal function is a frequent finding. Scarring may occur even in asymptomatic patients without vesicoureteric reflux.
Materials and methods
Fifty-three children (43 M:10 F, mean age:5.3 years; range 2-10 years) with evidence of recurrent UTI were enrolled in the study. Patients with duplex or crossed fused ectopic kidneys and with acute or chronic renal failure were excluded from the study protocol. Each patient underwent 99mTc-DMSA and 99mTc-EC renal scintigraphy within a period of 2 weeks.
Results
Analysis of results was performed by comparing the diagnostic accuracy of the summed 99mTc-EC and 99mTc-DMSA images for the detection of renal cortical scars and correlation (linear regression analysis) between the two renal scintigraphic procedures for the estimation of differential renal function. 99mTc-DMSA imaging demonstrated scarring in 41 kidneys whereas 99mTc-EC scintigraphy revealed scarring in 29/41 kidneys only. The percentage function of both kidneys with 99mTc-EC and 99mTc-DMSA showed good correlation. The r2 for left kidney was 0.95 and for right kidney was 0.94.
Conclusion
99mTc-EC scintigraphy has low sensitivity (70%) for the detection of cortical scarring as compared to 99mTc-DMSA (100%) renal imaging. On the hand, 99mTc-DMSA static imaging gives good estimate for the DRF and the values are in good agreement with the corresponding values derived from dynamic 99mTc-EC scanning.
How to cite this article
Raja S, Pareek V, Singh B, Sharma S, Rao KLN, Mittal BR. Comparison of 99mTc-Ethylene Dicysteine and 99mTc-Dimercaptosuccinic Acid Scintigraphy for the Evaluation of Cortical Scarring and Differential Renal Function in Children with Recurrent Urinary Tract Infection. J Postgrad Med Edu Res 2012;46(4):183-186.
Technetium 99m dimercaptosuccinic acid renal scintigraphy in children with acute pyelonephritis: Correlation with other imaging tests. Iran J Kidney Dis 2010;4(4):297-301.
Long-term follow-up to determine the prognostic value of imaging after UTI. Part 1: Reflux. Arch Dis Child 1995;72:388-92.
Renal pathology and the 99mTc-DMSA image during the evolution of the early pyelonephritic scar: An experimental study. J Urol 1994;151:767-73.
The pathogenesis of reflux nephropathy (chronic atrophic pyelonephritis). Br J Radiol 1975;(Suppl 13):1-26.
Reflux nephropathy in children submitted to unilateral nephrectomy: A clinicopathological study. Clin Nephrol 1993;40:308-14.
Studies of the retention mechanism of the brain perfusion imaging agent Tc-99m–bicisate (Tc-99m-ECD). J Cereb Blood Flow Metab 1994;14(suppl):S4-S11.
Metabolism of Tc-99m–LL-ethyl cysteinate dimer in healthy volunteers. Neuropharmacology 1991;30:283-92.
Role of technetium-99m N, N–Ehtylenedicysteine renal scintigraphy in the evaluation of differential renal function and cortical defects. Clin Nucl Med 2006;31:134-38.
Can Tc-99m mercaptoacetyl–triglycine replace Tc-99m DMSA in the exclusion of a focal renal defect? J Nucl Med 1992;33:2090-93.
Replacing DMSA for imaging? Nucl Med Commun 1992;13:494-96.
Evaluation of Tc-99mL, L-ethylenedicysteine as a potential alternative to Tc-99m MAG3. Eur J Nucl Med 1990;16:429
Tc-99m N, N–ethylenedicysteine scintigraphy in children with various renal disorders: A comparative study with various renal disorders: A comparative study with Tc-99m–MAG3. Nucl Med Commun 1997;18:771-75.
Technetium-99m-L, L-ethylenedicysteine renal scan as a single–modality investigation for the evaluation of renal morphology and function: A comparative study with Technetium-99m-dimercapto succinic acid. Nucl Med Commun 2004;25:743-47.
Comparison of 99mTc-DMSA dual head SPECT versus high-resolution parallel–hole planar imaging for the detection of renal cortical defects. Am J Roentgenol 2009;193:333-37.
Assessment of clinical usefulness of parametric clearance images in diagnosis of kidney cicatrisation in children with chronic infections of the urinary tract. Nucl Med Rev Cent East Eur 2010;13(1):8-14.