Stellenwert der ^99 mTc-DMSA-Szintigrafie bei der Behandlung von Kindern mit Harnwegsinfektionen

Zusammenfassung

Die ^99mTc-DMSA-Szintigrafie des Nierenparenchyms wird allgemein als eine hochsensitive Technik zum Nachweis von umschriebenen Defekten anerkannt. Sie kann mit großer Genauigkeit histologische Veränderungen erkennen und die Interobserver-Reproduzierbarkeit bei der Beurteilung der Befunde ist hoch. Mögliche technische Fehler sollten jedoch beachtet werden, wie insbesondere die Normvarianten der Niere sowie die Schwierigkeiten bei der Differenzierung von akuten Defekten gegenüber narbigen Veränderungen. Ebenso sollten erworbene von kongenitalen Defekten unterschieden werden. Obwohl die DMSA-Szintigrafie nicht eine wesentliche Rolle bei der traditionellen Therapie der Harnwegsinfektion zu spielen scheint, weisen neuere Studien darauf hin, dass dieses nuklearmedizinische Untersuchungsverfahren die Behandlung der akuten Phase der Infektion sowie die Indikation zur Antibiotikaprophylaxe und zur Durchführung eines MCU ebenso beeinflussen kann, ebenso wie die Dauer der Nachkontrollen.

Abstract

Cortical ^99mTc DMSA scintigraphy is accepted as a highly sensitive technique for the detection of regional lesions. It reflects accurately the histological changes and the interobserver reproducibility in reporting is high. Potential technical pitfalls should be recognized, such as the normal variants and the difficulty to differentiate acute lesions from permanent ones, or acquired lesions from congenital ones. Although DMSA scintgraphy seems to play a minor role in the traditional approach of urinary tract infection, recent studies suggest that this examination might influence the treatment of the acute phase, the indication of chemoprophylaxis and of micturating cystography, as well as the duration of follow-up.

Schlüsselwörter

DMSA-Szintigrafie - Harnwegsinfekt - Nierenparenchymdefekte - MCU

Key words

DMSA scintigraphy - urinary-tract-infection - renal cortical defect - micturating cystography

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