Download PDF
Aktuelle Urol 2020; 51(02): 151-157
DOI: 10.1055/a-0965-4609
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Refluxdiagnostik − Pro DMSA

The value of DMSA scintigraphy in the diagnostic evaluation of vesicoureteric reflux
Bernhard Haid
Abteilung für Kinderurologie, Ordensklinikum Linz, Krankenhaus der Barmherzigen Schwestern, Linz
› Author Affiliations
Further Information

Publication History

Publication Date:
09 October 2019 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Der vesikoureterale Reflux als radiologisches Phänomen tritt heutzutage, was die Planung der weiteren Therapie betrifft, gegenüber dem assoziierten Risiko für weitere Harnwegsinfekte und Nierenfunktionsverlust in den Hintergrund. Während die konventionelle und sonografische Miktionszysturethrografie der Goldstandard im bloßen Nachweis des vesikoureteralen Refluxes darstellen, spielt die Dimercaptosuccinylsäure-Szintigrafie eine wesentliche Rolle in der Risikostratifizierung. Überdies dient sie zum sicheren Nachweis einer Nierenmitbeteiligung bei fieberhaften Harnwegsinfekten in unklaren Situationen. Bei älteren Kindern ist sie der Standard in der Primärdiagnostik, sie erlaubt weiters den Nachweis eines okkulten Refluxes. Somit ist die Dimercaptosuccinylsäure-Szintigrafie ein wesentliches Werkzeug in der Diagnostik beim vesikoureteralen Reflux.

Abstract

In terms of treatment planning, the radiologic phenomenon of vesicoureteric reflux has become less important than its inherent risk of further urinary tract infections and loss of renal function. Whilst radiologic and sonographic voiding cystourethrography continues to be the gold standard in the mere detection of vesicoureteric reflux, dimercaptosuccinic acid scanning is important for risk stratification. Also it serves to confirm renal involvement in uncertain situations with urinary tract infection and fever. In older children, it is the standard in primary diagnostics. Furthermore, it enables the diagnosis of occult reflux in many cases. Therefore, dimercaptosuccinic acid scanning is an indispensable tool in the diagnostic evaluation of vesicoureteric reflux.

Schlüsselwörter

DMSA-Szintigrafie - Vesikoureteraler Reflux - Harnwegsinfektion

Keywords

DMSA scintigraphy - vesicoureteric reflux - urinary tract infection
 

  • Literatur

  • 1 Jacobson SH, Hansson S, Jakobsson B. Vesico-ureteric reflux: occurrence and long-term risks. Acta Paediatr Suppl 1999; 88: 22-30
    CrossrefPubMedSearch in Google Scholar
  • 2 Calderon-Margalit R, Golan E, Twig G. et al. History of Childhood Kidney Disease and Risk of Adult End-Stage Renal Disease. N Engl J Med 2018; 378: 428-438
    Search in Google Scholar
  • 3 Rushton HG, Majd M, Chandra R. et al. Evaluation of 99mtechnetium-dimercapto-succinic acid renal scans in experimental acute pyelonephritis in piglets. J Urol 1988; 140: 1169-1174
    CrossrefPubMedSearch in Google Scholar
  • 4 Majd M, Rushton HG, Jantausch B. et al. Relationship among vesicoureteral reflux, P-fimbriated Escherichia coli, and acute pyelonephritis in children with febrile urinary tract infection. J Pediatr 1991; 119: 578-585
    CrossrefPubMedSearch in Google Scholar
  • 5 Majd M, Nussbaum Blask AR, Markle BM. et al. Acute pyelonephritis: comparison of diagnosis with 99mTc-DMSA, SPECT, spiral CT, MR imaging, and power Doppler US in an experimental pig model. Radiology 2001; 218: 101-108
    CrossrefPubMedSearch in Google Scholar
  • 6 Bush NC, Keays M, Adams C. et al. Renal damage detected by DMSA, despite normal renal ultrasound, in children with febrile UTI. Journal of Pediatric Urology 2015; 11: 126.e1-126.e7
    CrossrefPubMedSearch in Google Scholar
  • 7 Piepsz A, Colarinha P, Gordon I. et al. Guidelines on 99mTc-DMSA scintigraphy in children. https://eanm.org/publications/guidelines/gl_paed_dmsa_scin.pdf
    PubMed
  • 8 Mandell GA, Eggli DF, Gilday DL. et al. Society of Nuclear Medicine Procedure Guideline for Renal Cortical Scintigraphy in Children. 2003
    PubMedSearch in Google Scholar
  • 9 Gelfand MJ, Clements C, MacLean JR. Nuclear Medicine Procedures in Children_ Special Considerations. Seminars in Nuclear Medicine 2017; 47: 110-117
    CrossrefPubMedSearch in Google Scholar
  • 10 Pintelon H, Jonckheer MH, Piepsz A. Paediatric nuclear medicine procedures: routine sedation or management of anxiety?. Nucl Med Commun 1994; 15: 664-666
    CrossrefPubMedSearch in Google Scholar
  • 11 Smith T, Evans K, Lythgoe MF. et al. Radiation dosimetry of technetium-99m-DMSA in children. J Nucl Med 1996; 37: 1336-1342
    PubMedSearch in Google Scholar
  • 12 Piepsz A, Colarinha P, Gordon I. et al. Guidelines for 99mTc-DMSA scintigraphy in children. European journal of nuclear medicine 2001; 28: BP37-BP41
    PubMedSearch in Google Scholar
  • 13 Mattoo TK, Skoog SJ, Gravens-Mueller L. et al. Interobserver variability for interpretation of DMSA scans in the RIVUR trial. Journal of Pediatric Urology 2017; 13: 616.e1-616.e6
    CrossrefPubMedSearch in Google Scholar
  • 14 Mantadakis E, Vouloumanou EK, Georgantzi GG. et al. Acute Tc-99m DMSA Scan for Identifying Dilating Vesicoureteral Reflux in Children: A Meta-analysis. Pediatrics 2011; 128: e169-e179
    CrossrefPubMedSearch in Google Scholar
  • 15 Shaikh N, Spingarn RB, Hum SW. Dimercaptosuccinic acid scan or ultrasound in screening for vesicoureteral reflux among children with urinary tract infections. Cochrane Database Syst Rev 2016; 7: CD010657
    PubMedSearch in Google Scholar
  • 16 Lee JH, Kim MK, Park SE. Is a routine voiding cystourethrogram necessary in children after the first febrile urinary tract infection?. Acta Paediatr 2011; 101: e105-e109
    PubMedSearch in Google Scholar
  • 17 Suson KD, Mathews R. Evaluation of children with urinary tract infection - Impact of the 2011 AAP guidelines on the diagnosis of vesicoureteral reflux using a historical series. Journal of Pediatric Urology 2014; 10: 182-185
    CrossrefPubMedSearch in Google Scholar
  • 18 Pohl HG, Belman AB. The “top-down” approach to the evaluation of children with febrile urinary tract infection. Adv Urol 2009;
    CrossrefPubMedSearch in Google Scholar
  • 19 Harper L, Lefevre Y, Delforge X. et al. Children with abnormal DMSA nuclear scan present a higher risk of recurrent febrile urinary tract infections. World J Pediatr 2019; 15: 204-205
    CrossrefPubMedSearch in Google Scholar
  • 20 Hoberman A, Charron M, Hickey RW. et al. Imaging Studies after a First Febrile Urinary Tract Infection in Young Children. N Engl J Med 2003; 348: 195-202
    CrossrefPubMedSearch in Google Scholar
  • 21 Imamura M, Hayashi C, Kim WJ. et al. Renal scarring on DMSA scan is associated with hypertension and decreased eGFR in spina bifida patients in the age of transition to adulthood. Journal of Pediatric Urology 2018;
    CrossrefPubMedSearch in Google Scholar
  • 22 Hollowell JG. Outcome of pregnancy in women with a history of vesico-ureteric reflux. BJU International 2008; 102: 780-784
    CrossrefPubMedSearch in Google Scholar
  • 23 Holmdahl G, Brandström P, Läckgren G. et al. The Swedish reflux trial in children: II. Vesicoureteral reflux outcome. The Journal of Urology 2010; 184: 280-285
    CrossrefPubMedSearch in Google Scholar
  • 24 Oh MM, Jin MH, Bae JH. et al. The role of vesicoureteral reflux in acute renal cortical scintigraphic lesion and ultimate scar formation. The Journal of Urology 2008; 180: 2167-2170
    CrossrefPubMedSearch in Google Scholar
  • 25 Shaikh N, Mattoo TK, Keren R. et al. Early Antibiotic Treatment for Pediatric Febrile Urinary Tract Infection and Renal Scarring. JAMA Pediatr 2016; 170: 848-854
    CrossrefPubMedSearch in Google Scholar
  • 26 Ransley PG, Risdon RA. Renal papillary morphology in infants and young children. Urol Res 1975; 3: 111-113
    PubMedSearch in Google Scholar
  • 27 Coulthard MG, Flecknell P, Orr H. et al. Renal scarring caused by vesicoureteric reflux and urinary infection: a study in pigs. Pediatr Nephrol 2002; 17: 481-484
    CrossrefPubMedSearch in Google Scholar
  • 28 Coulthard MG. Vesicoureteric reflux is not a benign condition. Pediatr Nephrol 2009; 24: 227-232
    CrossrefPubMedSearch in Google Scholar
  • 29 Hansson S, Dhamey M, Sigström O. et al. Dimercapto-succinic acid scintigraphy instead of voiding cystourethrography for infants with urinary tract infection. J Urol 2004; 172: 1071-1073
    CrossrefPubMedSearch in Google Scholar
  • 30 Rubenstein JN, Maizels M, Kim SC. et al. The Pic Cystogram: A Novel Approach to Identify “Occult” Vesicoureteral Reflux in Children with Febrile Urinary Tract Infections. The Journal of Urology 2003; 169: 2339-2343
    CrossrefPubMedSearch in Google Scholar
  • 31 Berger C, Becker T, Koen M. et al. Positioning irrigation of contrast cystography for diagnosis of occult vesicoureteric reflux: association with technetium-99m dimercaptosuccinic acid scans. J Pediatr Urol 2013; 9: 846-850
    CrossrefPubMedSearch in Google Scholar
  • 32 Karadeniz-Cerit K, Thomas DT, Ergun R. et al. Positional installation of contrast (PIC) and Redo-PIC cystography for diagnosis of occult vesicoureteral reflux. Turk J Pediatr 2018; 60: 180-187
    PubMedSearch in Google Scholar
  • 33 Johnin K, Kobayashi K, Tsuru T. et al. Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children. Int J Urol 2018; 15: 105-112
    PubMedSearch in Google Scholar
  • 34 Balestracci A, Montecuco M, Serviddio C. et al. Role of Late DMSA Renal Scan in Detecting High-Grade Vesicoureteral Reflux. Indian J Pediatr 2019; 86: 784-789
    CrossrefPubMedSearch in Google Scholar
  • 35 Bosakova A, Salounova D, Havelka J. et al. Diffusion-weighted magnetic resonance imaging is more sensitive than dimercaptosuccinic acid scintigraphy in detecting parenchymal lesions in children with acute pyelonephritis: a prospective study. Journal of Pediatric Urology 2018; 14: 269.e1-269.e7
    CrossrefPubMedSearch in Google Scholar