Renal artery revascularisation can restore kidney function with absent radiotracer uptake

Background

Children with renovascular hypertension often present with severe hypertension. Some children have severe obstruction of their renal arteries resulting in <10% relative function on [^99mTc]dimercaptosuccinic acid (DMSA) scan. Conventional treatment of these children has been nephrectomy of the poorly functioning kidney to normalise their blood pressure (BP).

Case-Diagnosis/treatment

We describe three children aged 20 months to 9 years with severe renal artery stenosis and severe hypertension who had radionucleotide uptake of 0% in one kidney. In one case, no renal perfusion was demonstrated by duplex ultrasound scan. Significant recovery of relative renal function of 18 to 52% was achieved after revascularisation by percutaneous angioplasty or open surgery of the obstructed renal artery.

Conclusion

These cases illustrate that scintigraphy alone cannot be used to predict salvageable function in children with renovascular disease.     

Prediction of residual total renal function before nephron-sparing surgery using99mTc-DMSA renal scintigraphy

Background Although radical nephrectomy is the standard treatment for renal cell carcinoma, nephron-sparing surgery is the preferred treatment in patients with a single functioning kidney. It is important before surgery to evaluate the level of residual renal function likely after the operation. In this study, we investigated the prediction of residual renal function, using technetium Tc 99m dimercaptosuccinic acid (^99mTc-DMSA) renal scintigraphy, before nephron-sparing surgery for renal tumors. Methods Preoperative and postoperative evaluation of renal function was done in 11 patients with renal cell carcinoma or renal angiomyolipoma, using^99mTc-DMSA scintigraphy. Nine patients had renal cell carcinoma and 2 had renal angiomyolipoma. Partial nephrectomy was performed in 4 patients and surgical enucleation in 7 patients. Both the predicted total DMSA renal uptake rate prior to surgery and the actual postoperative total^99mTc-DMSA renal uptake rate were obtained. Endogenous creatinine clearance and serum creatinine levels were also obtained. Results There was a good relationship between the predicted and postoperative total^99mTc-DMSA renal uptake rates. The ratio of the postoperative total DMSA renal uptake rate to the predicted total^99mTc-DMSA renal uptake rate was 85% after partial nephrectomy, and 101% after surgical enucleation. There was also a significant correlation between the postoperative total^99mTc-DMSA renal uptake rate and creatinine clearance, and postoperative total^99mTc-DMSA renal uptake rate levels above 11.4% coincided with serum creatinine levels below 2.0 mg/dL. Conclusion Preoperative assessment with^99mTc-DMSA renal scintigraphy is clinically useful for predicting residual renal function after nephron-sparing surgery.     

The importance of99mTc DMSA scanning in the localization of childhood urinary tract infections

The use of^99mTechnetium dimercaptosuccinic acid (^99mTc DMSA) scanning for the early diagnosis of upper urinary tract infections has been preferred for a few years. In this research we investigated the use of^99mTc DMSA scanning in the localization of renal parenchymal involvement in urinary tract infection. Twenty-four children presenting with first acute urinary tract infection were studied. Investigations included physical examination, white blood cell count (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), antibody-coated bacteria (ACB) and early^99mTc DMSA scanning.^99mTc DMSA scanning was taken as the gold standard method in determining renal parenchymal inflammation. According to the^99mTc DMSA scanning the sensitivity of clinical findings was 57.14%, WBC 23.80%, ESR 33.33%, CRP 14.28% and ACB 71.42% in the localization of urinary tract infection. We propose early^99mTc DMSA scanning performed around the time of infection as a good technique for localization of the level of infection in the urinary tract.     

Radionuclide imaging of the urinary tract

Summary Nuclear medicine procedures for urology have evolved during the past three decades. This article reviews the utility of the procedures, placing special emphasis on new developments and indications. The new radiopharmaceutical technetium Tc99m mercaptoacetyltriglycine ([^99mTc]-MAG3), which is excreted via tubular secretion, is likely to replace technetium Tc99m diethylenetriaminepentacetic acid ([^99mTc]-DTPA) and iodine I131 orthoiodohippurate ([¹³¹I]-OIH) as the most desirable agent for renal radionuclide examinations. The most common uses of renal radionuclide examinations are to evaluate equivocal urinary obstruction and to evaluate renal transplants. Renewed interest in renography for hypertension has resulted from the use of Captopril as an adjunct to renography. Bone scintigraphy is more sensitive than radiography in detecting metastatic bone lesions, but other bone abnormalities can produce false-positive findings. Scrotal scintigraphy is very accurate as an aid in differentiating testicular torsion from other acute scrotal abnormalities. The major advantage of nuclear cystograms is decreased exposure of the patient to radiation.     

Captopril-enhanced 99mTc DTPA Scintigraphy in the Detection of Renal-artery Stenosis

The value of captopril-enhanced ^99mTc DTPA scintigraphy as ascreening test for renovascular disease was prospectively studiedin 44 hypertensive patients suspected to have renal-artery stenosis.Renal impairment (plasma creatinine >130umol/l) was presentin 29 patients. At angiography 13 patients had unilateral stenosis,two bilateral stenosis, and 29 patients had no renovasculardisease. Captopril induced a fall in split renal function inthe kidney ipsilateral to the stenosis in all patients withunilateral disease (mean 52 ± 23% to 44 ± 21%of total renal function; P <0.001). A positive captoprilscintigram (defined as a fall of 5% or more in split renal function)had a sensitivity of 85% and a specificity of 72% in the detectionof unilateral renal-artery stenosis. Captopril-enhanced ^99mTcDTPA scintigraphy is a promising non-invasive screening testfor the detection of renal-artery stenosis.     

Current roles and controversies in the imaging evaluation of acute renal infection

The current roles and controversies in imaging of the kidneys for the evaluation of patients with acute renal infection are reviewed. The nomenclature used in describing the extent of the renal imaging findings in acute pyelonephritis suggested by the Society of Uroradiology to help avoid confusion in terminology in the past literature is briefly described. Computed tomography (CT) is superior to urography and renal sonography for the evaluation and management of adults with acute renal infection. [^99mTc]-dimercapto succinic acid (DMSA) cortical scintigraphy is the imaging study for the evaluation of children with acute pyelonephritis investigated by some, although power Doppler ultrasound, and even CT, can be considered as a possible alternative.     

Estimation of Differential Renal Function in Children With a Prenatal Diagnosis of Unilateral Pelvic Dilatation

Purpose

We compared the estimation of differential renal function by sup 99m technetium (Tc)-dimercapto-succinic acid (DMSA) and ^99mTc-pentetic acid scintigraphic methods for followup of prenatally diagnosed unilateral renal pelvic dilatation.

Materials and Methods

We retrospectively analyzed differential renal function estimations calculated by static and dynamic methods in time matched test pairs that were included in the charts of 51 children monitored for prenatally diagnosed unilateral renal pelvic dilatation at our institution in a 5-year period.

Results

There were 96 test pairs with available archived raw data. Using the analytic method of assessment of agreement between the 2 tests, a 95% limit of agreement of +/−9% was calculated. Of the 96 pairs of tests the results of 94 revealed no significant difference. Subgroup analysis by patient age and operative intervention (13 postoperative pairs) also showed no difference in the results of the 2 tests.

Conclusions

We established the 95% limits of agreement between ^99mTc-DMSA and ^99mTc-pentetic acid tests of differential renal function to be +/−9% discrepancy in 96 test pairs. During followup of prenatally diagnosed unilateral renal pelvic dilatation the assessment of differential renal function can be made by ^99mTc-DMSA static or dynamic diuretic renography techniques. This interchangeability is consistent at all patient ages regardless of operative intervention. Since dynamic diuretic renography provides differential function and drainage data, using ^99mTc-DMSA in this context is unnecessary and subjects patients to an unnecessary radiation burden.     

Optimizing preoperative imaging in primary hyperparathyroidism

Background Scintigraphy of the hyperfunctioning parathyroid glands using technetium 99m (^99mTc)-methoxyisobutylisonitrile (^99mTc-MIBI) is an established and highly sensitive preoperative localization tool whose importance has been further increased by advances in minimally invasive surgery .The goal of the present prospective study was to determine the benefit of optimized imaging in a consistent patient population.Methods Eighty-four patients with first presentations of primary hyperparathyroidism were investigated with ^99mTc-MIBI scintigraphy, thyroid scintigraphy, and cervical ultrasonography. The evaluation algorithm consisted of (a) evaluation of the planar images alone, (b) additional evaluation of single-photon emission computed tomography (SPECT), (c) additional evaluation of thyroid gland scintigraphy, and (d) additional evaluation of ultrasound. All patients subsequently underwent parathyroidectomy. The intraoperative and the histologic findings were correlated with the results of the scintigraphic imaging.Results The sensitivity of planar parathyroid scintigraphy was 74% and could be increased to 91% by the additional investigations. The difference was statistically significant (p<0.05). At the same time, a small increase in specificity from 96% to 99% was seen.Conclusions Prior to minimally invasive treatment of hyperparathyroidism, we recommend combined localization studies consisting of sequential ^99mTc-MIBI scintigraphy, additional SPECT plus thyroid gland scintigraphy, plus high-resolution cervical ultrasonography.     

Evaluation of autosomal dominant polycystic kidney disease by DTPA renal scintigraphy

Sixty patients with previously documented autosomal dominant polycystic kidney disease (ADPKD) were investigated using dynamic kidney scintigraphy with^99mTc-diethylenetriaminepentaacetic acid (DTPA). Patients were subdivided in respect of glomerular filtration rate (GFR) as follows: PKD I group (normal GFR), PKD II group (moderately reduced GFR), and PKD III (severely reduced GFR). Seintigraphic features, time activity curves, excretion parameters, global and individual kidney functions were analyzed. Because of GFR dependent sensitivity, in advanced renal failure being only 0.1, and low reproducibility (11% intraobserver, 22% interobserver),^99mTc-DTPA dynamic kidney scintigraphy cannot be generally recommended for the diagnosis of ADPKD, but has to become a routine method for functional evaluation of both global and individual renal functions, as well as degree of excretion disturbances in ADPKD patients.     

Ecografía Doppler renal con medición de índices de resistencia vs. gammagrafía renal con 99mTc-DTPA para el diagnóstico de estenosis ureteropiélica en niños

ObjectiveA cross-sectional study was carried out with the objective of evaluating the usefulness of Doppler ultrasound with resistive index (RI) measure compared with renal scintigraphy with ^99mTc-DTPA in children with unilateral ureteropelvic junction obstruction.MethodsThe study included children under 15 years with a diagnosis of unilateral ureteropelvic junction obstruction, healthy contralateral kidney with or without an antecedent of ureteropyeloplasty. The selected patients were sent to the Nuclear Medicine Department to carry out a renal scintigraphy with ^99mTc-DTPA and days later were sent to the Radiology Department for the performance of Renal Doppler Ultrasound with RI.ResultsA total of 21 patients were included in the study, 15 males and 6 females, representing 71.4% and 28.6%, respectively. Mean age was 5.3 years. Only 3 had an antecedent of ureteropyeloplasty in the affected kidney. The scintigraphy reported data of unilateral obstruction in 18 patients, including the 3 patients with previous surgery. The average glomerular filtration rate (GFR) obtained with the scintigraphy was 100.28 ml/min. The average GFR in affected kidneys was 43.03 ml/min and 57.24 ml/min in healthy kidneys (p < .001). Doppler ultrasound with RI reported ectasia in 100% of the affected kidneys and one normal contralateral kidney. The average RI in affected kidneys was 0.69 mm/s and 0.50 mm/s in healthy kidneys (p < .001).ConclusionsWith the results obtained, we can suggest that ultrasound Doppler with measurement of RI can be an alternative tool to renal scintigraphy with ^99mTc-DTPA in some cases.     

Litotricia extracorpórea en niños. Eficacia y evaluación a largo plazo de la lesión del parénquima renal mediante gammagrafía con DMSA-99mTc

PurposeTo determine the effectiveness of extracorporeal shock-wave lithotripsy (ESWL) and possible deleterious effects on renal parenchyma of children subjected to treatment of renal lithiasis, using renal scintigraphy with 99mTc dimercapto-succunic acid (DMSA).Patients and methodsFrom January 2004 to November 2007, 18 children (age 3-10 years) underwent ESWL (Philips-Dornier) for kidney urolithiasis. All patients underwent preoperative evaluation, including physical examination, urine culture, image exams and renal scintigraphy with Tc99-DMSA. Evaluation after treatment consisted of a clinical examination, blood pressure measurement, urine culture, renal ultrasound and Tc99-DMSA, repeated at 3, 6 and 12 months, which were compared to the scans obtained before ESWL to determine possible morphological or functional changes.ResultsSuccess in the stones fragmentation was achieved in all cases – in 9 patients (50%) with one session of ESWL, in 6 (33%) with two sessions and in 3 patients (17%) with 3 sessions of ESWL. Only one patient (5%), after three sessions of ESWL and 6 months of follow-up showed change in size of right kidney with a decrease in tubular function, without hypertension or other major changes. In the other cases, there was absence of hypertension up to 12 months of follow-up, absence of renal hematomas detected by ultrasound or significant renal scars in scintigraphic examinations.ConclusionESWL is effective and safe for treating renal lithiasis in children. Renal parenchyma lesions may occur early after treatment, but these lesions are transients and resolve spontaneously in virtually all cases; generally, there are no irreversible renal lesions associated with ESWL, even after the follow-up period with clinical examination, ultrasound examination and 99mTc-DMSA scintigraphy.     

Surgery for renovascular diseases: a single-center experience in revascularizing renal artery stenosis and aneurysm.

OBJECTIVE: Diagnosis and management of renovascular diseases (RVD) at Hokkaido University Hospital was reviewed with particular emphasis on surgical revascularization (SR). PATIENTS AND METHODS: We studied a total of 33 patients with RVD [16 patients with renal artery stenosis (RAS): group 1, and 17 patients with renal artery aneurysm (RAA): group 2, 10 males, 23 females, aged 9-69 years (median 46), unilateral 24, bilateral 9]. Functional diagnosis of RVD with regard to renovascular hypertension (RVH) was done with the captopril test (CP-T) and captopril-enhanced (99m)Tc-DTPA (diethylenetriamine-pentaacetic acid) renal scintigraphy (CER). All were subjected to SR. Number, length, size and site of RVD with involvement of branch arteries dictated the choice of operative method but basically in situ repair for main trunk disease (11 kidneys) and ex vivo bench repair with autotransplantation for those beyond the first bifurcation intrarenally involving branched arteries (24 kidneys) were employed. The outcome was analyzed as to blood pressure control, split renal function, and branch renal artery patency. RESULTS: (1) Sensitivity of CP-T and CER was 79 and 77% respectively in group 1, while it was 40 and 38% respectively in group 2. (2) Blood pressure was cured in 66.7% (group 1, 68.8% and group 2, 63.6%) and improved in 22.2% (group 1, 18.8% and group 2, 27.3%) with an overall success rate of 88.9%. (3) Renal function was good in 81.3% (group 1, 83.3% and group 2, 78.6%) and fair in 9.4% (group 1, 0% and group 2, 21.4%) with overall success in 90.7%. (4) Patency was preserved in 90.5% of branch anastomoses. CONCLUSIONS: Despite challenging complexities, SR of RVD is feasible with a reasonable amount of morbidity and effective in controlling blood pressure and preserving renal function in the majority of cases.     

Assessment of liver graft function and regeneration by galactosyl-human serum albumin (99mTc-GSA) liver scintigraphy in adult living-donor liver transplantation

Abstract: Background: In adult living‐donor liver transplantation (LDLT), the assessment of the graft functional reserve is very important. We evaluated the graft functional reserve by technetium‐99m‐diethylenetriaminepenta‐acetic acid‐galactosyl‐human serum albumin (^99mTc‐GSA) liver scintigraphy. Patients and method: From May 2003 to September 2006, ^99mTc‐GSA studies were performed in 27 adult recipients on two, four wk after LDLT, the receptor index [ratio of liver to heart‐plus‐liver radioactivity at 15 minutes (LHL15)] (LHL15) was calculated. Recipients were divided into two groups according to LHL15 on two wk after LDLT (group H; >0.935, group L; <0.935). Liver functional tests and recipients’ background parameters were evaluated between the two groups. Result: Group L accompanied higher preoperative model for end‐stage liver disease (MELD) score (p = 0.038), lower graft‐recipient weight ratio (GRWR) (p = 0.032) and older donor age (p = 0.003) compared with group H. There was no significant difference in the graft regeneration rate between two groups. The three‐yr cumulative survival rate was 76.1% in group L and 88.9% in group H. Conclusion: In LDLT, LHL15 has the potential to assess the graft function and predict the recipients’ outcome. Graft function after LDLT may be related closely to the pretransplant MELD score, GRWR, and donor age.     

Reproducibility of Computed Tomography Volumetry for Predicting Post-Donation Remnant Renal Function: A Retrospective Analysis

BackgroundRecent studies indicate that split renal function calculated by computed tomography (CT) volumetry is equally or more useful than that calculated by nuclear renography for donated kidney side selection. However, it remains unclear if CT volumetry accurately reflects split renal function as measured by nuclear renography. Therefore, this study aimed to evaluate the reproducibility of CT volumetry.MethodsData from 141 donors who underwent living donor nephrectomy at Nara Medical University from March 2007 to June 2021 were reviewed. The correlation and agreement between the predicted postdonation estimated glomerular filtration rate (eGFR) by ^99mTc-diethylenetriamine penta-acetic acid (DTPA) scintigraphy and by CT volumetry were evaluated by the Pearson's correlation coefficient and Bland-Altman analysis, respectively. Moreover, a comparison in split renal function categorization between ^99mTc-DTPA scan and CT volumetry was performed.ResultsA total of 133 donors were included in the analysis. There was high correlation between the predicted postdonation eGFR by ^99mTc-DTPA scintigraphy and by CT. Moreover, there was agreement in the predicted postdonation eGFR between ^99mTc-DTPA scintigraphy and CT volumetry (Bland-Altman analysis [bias, 95% limits of agreement]; 0.83%, -5.6% to 7.3%). However, in one of 17 donors with absolute split renal function greater than 10% by ^99mTc-DTPA scintigraphy, this clinically significant difference was missed by CT volumetry.ConclusionThere are donors for whom a clinically significant split renal function is not accurately reflected in CT volumetry. Future studies need to amend this discrepancy.     

Renal damage caused by warm ischaemia during laparoscopic and robot-assisted partial nephrectomy: an assessment using Tc 99m-DTPA glomerular filtration rate

Background

Few studies assessing the functional change of each kidney following warm ischaemia after partial nephrectomy are available.

Objectives

Our aim was to identify the effects of the warm ischaemic time (WIT) on renal function after partial nephrectomy under the pneumoperitoneum.

Design, setting, and participants

Forty-four consecutive patients who underwent laparoscopic partial nephrectomy (LPN) or robot-assisted partial nephrectomy (RAPN) from June 2008 to May 2009 for a single cT1 renal tumour were included in this prospective protocol.

Measurements

Technetium Tc 99m-diethylenetriaminepentaacetic acid (Tc 99m-DTPA) renal scintigraphy was used to determine the glomerular filtration rate (GFR) of both kidneys and each kidney individually. Tc 99m-DTPA GFR was performed preoperatively and 3 mo postoperatively. In addition, we analysed Tc 99m-DTPA scintigraphy GFR regionally in the healthy areas of the affected kidney.

Results and limitations

Patients with WIT >28 min had a significantly greater decrease in the GFR of the affected kidney (p = 0.031). The GFR of the affected kidney showed a significant decrease perioperatively (46.4 ± 14.3 to 37.9 ± 11.9 ml/min per 1.73 m²; p = 0.003). The functional change of the nonaffected kidney showed an increasing trend (47.5 ± 13.8 to 51.4 ± 14.3 ml/min per 1.73 m²), although it was not statistically significant (p = 0.103). Regional Tc 99m-DTPA GFR of both affected kidney and nonaffected kidney showed no significant differences perioperatively (6.3 ± 1.8 to 6.1 ± 1.9 ml/min per 1.73 m²; p = 0.641; 6.6 ± 1.9 to 7.1 ± 2.0 ml/min per 1.73 m²; p = 0.200). On multivariate analysis, preoperative GFR, resected volume of marginal healthy tissue, and WIT were independent predictors for functional reduction of the affected kidney (p < 0.05). The study was limited by small numbers and short follow-up periods.

Conclusions

Stationary overall renal function after LPN or RAPN is masked possibly by functional compensation of the contralateral healthy kidney. The damage of the affected kidney estimated by scintigraphy occurs when WIT exceeds 28 min during partial nephrectomy under the pneumoperitoneum.     

The correlation between preoperative renal scintigraphy and postoperative renal function in upper urinary tract urothelial carcinoma patients following radical nephroureterectomy

ObjectiveTo predict the renal function after nephroureterectomy (NUR) for upper urinary tract urothelial cancer (UTUC) based on preoperative technetium-99m mercaptoacetyltriglycine (99mTc-MAG3) renal scintigraphy.Subjects and methodsWe retrospectively reviewed 238 patients who originally underwent nephroureterectomy for UTUC between 2007 and 2010. Of these patients, 129 underwent MAG3 renal scintigraphy before unilateral NUR. Serum creatinine was measured in all of the patients before surgery, and renal function was monitored for one year after surgery. Preoperative and postoperative eGFRs were compared and analyzed based on the preoperative MAG3 renal scintigraphy.ResultsA total of 129 patients, including 62 men (48%) and 67 women (52%) with an average age at surgery of 69.0 years (range from 48 to 87) were included in this study. The mean preoperative creatinine level was 1.42 mg/dL, and the baseline eGFR was 54.76 ml/min/1.73 m². One year after NUR, the mean creatinine level was 1.89 mg/dL, and the eGFR was 44.44 ml/min/1.73 m², a mean decrease of 18.73%. The preoperative effective renal plasma flow (ERPF) of the operated kidney was 91.65 ml/min/1.73 m², and that of the remaining kidney 158.30 ml/ min/1.73 m². The average preoperative ERPF of the resected kidney accounted for 34% of total preoperative ERPF, which was statistically significant in its relation to the decrease in eGFR. The decrease in eGFR ratio was also significantly correlated with the calculated decrease in ERPF ratio (R² = 0.279, p < 0.001). The predictive equation of renal function one year after NUR was established as following: eGFR decreased ratio = –0.80 × predictive ERPF decreased ratio +0.72.ConclusionWe developed an equation to predict postnephroureterectomy 1 year eGFR before surgery based on preoperative MAG3 renal scintigraphy results and preoperative eGFR. The equation could be more accurate in the situation if the diseased kidney is not hydronephrotic.     

Prediction of final tumor response to preoperative chemotherapy by Tc‐99m MIBI imaging at the middle of chemotherapy in malignant bone and soft tissue tumors: Comparison with Tl‐201 imaging

The aim of this study was to assess the predictive power of ^99mTc‐MIBI scintigraphy performed in the middle of chemotherapy, for the final tumor response to chemotherapy, and compare it to that of ²⁰¹Tl in malignant bone and soft tissue tumors (MBST). Sixty‐eight patients with MBST underwent ^99mTc‐MIBI and ²⁰¹Tl scintigraphies at 15 min after tracer injection before the first, and after the third, chemotherapy cycles. After five cycles of chemotherapy and tumor resection, therapeutic effect was assessed by histopathology. Less than 90% and ≥90% necrosis were judged as poor and good response to chemotherapy, respectively. Tracers uptake ratios were calculated by dividing the lesion count density by that of the background. ^99mTc‐MIBI perfusion index was also calculated. The % reduction of the perfusion index (ΔPI) and uptake ratios (ΔUR) calculated by 100 × [(prechemotherapy value ? postchemotherapy value)/prechemotherapy value] were compared with histologic response. The sensitivity, specificity, and accuracy for the prediction of effective chemotherapy in ^99mTc‐MIBI imaging were 80%, 95%, 88% in ΔUR, and 74%, 74%, 74% in ΔPI, respectively. The area under the receiver operator characteristic curve (A_z) of the ^99mTc‐MIBI‐ΔUR (0.923) was significantly higher than that of ΔPI (0.809, p = 0.025) but only marginally higher than that of the ²⁰¹Tl‐ΔUR (0.865, p = 0.079). A_z in ²⁰¹Tl (0.865) was not significantly different from that of ΔPI (0.809, p = 0.35). ^99mTc‐MIBI imaging performed in the middle of chemotherapy well predicts the final tumor response to chemotherapy in patients with malignant bone and soft tissue tumors. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 26:411–418, 2008     

Resistive index in febrile urinary tract infections: predictive value of renal outcome

In the absence of specific symptomatology in children, the early diagnosis of acute pyelonephritis is a challenge, particularly during infancy. In an attempt to differentiate acute pyelonephritis from lower urinary tract infection (UTI), we measured intrarenal resistive index (RI). We evaluated its ability to predict renal involvement as assessed by dimercaptosuccinic acid (DMSA) scintigraphy. In total 157 patients admitted to the pediatric department of the ili Etfal Hospital with clinical signs of febrile UTI were included in the study. The children were divided into groups according to their age at the time of ultrasonography (US). RI was measured from the renal arteries with Doppler US in the first 72 h in all 157 children. Renal involvement was assessed by ^99mTc-DMSA scintigraphy in the first 7 days after admission. The examination was repeated at least 6 months later if the first result was abnormal. All available patients with an abnormal scintigraphy underwent voiding cystourethrography 4–6 weeks after the acute infection. All patients with vesicoureteral reflux and scarred kidneys were excluded from the study. DMSA scintigraphy demonstrated abnormal changes in 114 of 157 children and was normal in the remaining 43 children. Of these 114 children, 104 underwent repeat scintigraphy, of whom 77 showed partially or totally reversible lesion(s). Of these 77 children, 17 children (22%) with vesicoureteral reflux were excluded. Thus, we compared the 43 children with lower UTI with the 60 children with definite acute pyelonephritis at admission. Kidneys with changes of acute pyelonephritis had a mean RI of 0.744±0.06 in infants, 0.745±0.03 in preschool children, and 0.733±0.09 in patients of school age with upper UTI. However, the mean RI was 0.703±0.06 in infants, 0.696±0.1 in preschool children, and 0.671±0.09 in school-aged patients with lower UTI. The mean RI values were significantly higher in patients with upper UTI (P<0.001). There was a highly significant correlation between RI values and the severity of the renal lesion as ranked by DMSA scintigraphy (P<0.001). When the cut-off RI value was 0.715, there was an 80% sensitivity and a 89% specificity for diagnosing upper UTI. Refluxing kidneys and scarred kidneys also had higher RI values. In conclusion, RI values were increased significantly in children with febrile UTI when renal parenchymal involvement (assessed by DMSA scintigraphy) was present. Our results also support the view that the children with high RI values are at a high risk of reflux, scarring, or both, which was frequently observed in febrile UTI. This might allow identification of patients at risk for severe renal lesions that require more aggressive therapy, investigation, and follow-up than those with lower UTI.An erratum to this article can be found at     

18F-fluorocholine PET/CT and conventional imaging in primary hyperparathyroidism

PurposeThe purpose of this study was to assess the diagnostic capabilities of preoperative conventional imaging (^99mTc-MIBI scintigraphy, cervical ultrasonography [CUS]) and ¹⁸F-fluorocholine PET/CT (FCH PET/CT) in the detection of hyperfunctioning parathyroid gland in patients with primary hyperparathyroidism (PHPT) used alone or as a single imaging set.Materials and methodsA total of 51 consecutive patients (6 men, 45 women; mean age, 62 ± 11.6 [SD] years; age range: 28–86 years) with biochemically confirmed PHPT who underwent CUS, single-tracer dual phase ^99mTc-MIBI scintigraphy and FCH PET/CT were retrospectively included. ^99mTc-MIBI scintigraphy were performed immediately after CUS and interpreted by the same operators. FCH PET/CT examinations were interpreted independently by two nuclear medicine physicians. An additional reading session integrating the three imaging modalities read in consensus as a combined imaging set was performed.ResultsAt surgery, 74 lesions were removed (32 parathyroid adenomas, 38 parathyroid hyperplasia and 4 subnormal glands). Thirty-six patients (71%) had single-gland disease and 15 patients (29%) had multiglandular disease at histopathological analysis. On a patient basis, sensitivity and accuracy of FCH PET/CT, CUS and ^99mTc-MIBI scintigraphy for the detection of abnormal parathyroid glands were 76% (95% CI: 63–87%) and 76% (95% CI: 63–87%), 71% (95% CI: 56–83%) and 71% (95% CI: 56–83%), 33% (95% CI: 21–48%) and 33% (95% CI: 21–48%), respectively. The sensitivity of the combined imaging set was 94% (95% CI: 84–99%) and greater than the sensitivity of each individual imaging technique (P ≤ 0.001 for all).ConclusionOur results suggest that CUS, ^99mTc-MIBI scintigraphy and FCH PET/CT interpreted as a single imaging set could be the ideal practice to precisely localize parathyroid lesion in patients with PHPT before surgery.