Role of scintigraphy in urinary tract infection

Journal Article · Sat Oct 01 04:00:00 EDT 1988 · Semin. Nucl. Med.; (United States)

DOI:https://doi.org/10.1016/S0001-2998(88)80040-0· OSTI ID:6353363

Conway, J J

There is controversy regarding the role of radiological imaging for urinary tract infection (UTI). The gold standard has been the intravenous pyelogram (IVP). Yet, the IVP has a very limited value with only about 25% of children with pyelonephritis demonstrating abnormalities. Ultrasound (US) has recently been advocated as a replacement for the poorly sensitive and poorly specific IVP. However, comparative studies between US and IVP indicate only an equivalent sensitivity and specificity. Cortical scintigraphy with Technetium-99m glucoheptonate (99mTc GH) or 99mTc dimercaptosuccinic acid (99mTc DMSA) has also been advocated as a means of differentiating parenchymal (pyelonephritis) from nonparenchymal (lower UTI) involvement in UTI. The clinical presentation may be misleading especially in the infant and child in whom an elevated temperature, flank pain, shaking chills, or an elevated sedimentation rate are often lacking. The clinician attempts to localize the site of infection for it has a direct bearing upon the therapy. A collecting system infection can often be eradicated with a single oral dose of an appropriate antibiotic, whereas renal parenchymal involvement requires IV therapy for an extended interval. Cortical scintigraphy can localize the site of infection with a high degree of accuracy. Recent studies report a sensitivity of 86% and specificity of 81% of pyelonephritis. This is in contrast to the IVP with a sensitivity of only 24% and US with a sensitivity of only 42%. The scintigraphic appearance of parenchymal infection of the kidney is a spectrum of minimal to gross defects reflecting the degree of histologic involvement that spans from a mild infection to frank abscess. Cortical scintigraphy can be used to monitor the evolution of scarring following infection. Cortical scintigraphy with 99mTc DMSA or 99mTc GH is the method of choice for the initial evaluation of UTI. 37 references.

• Research Organization: Children's Memorial Hospital, Chicago, IL (USA)
• OSTI ID: 6353363
• Journal Information: Semin. Nucl. Med.; (United States), Journal Name: Semin. Nucl. Med.; (United States) Vol. 18:4; ISSN SMNMA
• Country of Publication: United States
• Language: English

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550601* -- Medicine-- Unsealed Radionuclides in Diagnostics
62 RADIOLOGY AND NUCLEAR MEDICINE
AGE GROUPS
BETA DECAY RADIOISOTOPES
BETA-MINUS DECAY RADIOISOTOPES
BODY
CHILDREN
COUNTING TECHNIQUES
DIAGNOSIS
DIAGNOSTIC TECHNIQUES
DISEASES
DOCUMENT TYPES
HOURS LIVING RADIOISOTOPES
INTERMEDIATE MASS NUCLEI
ISOMERIC NUCLEI
ISOMERIC TRANSITION ISOTOPES
ISOTOPES
KIDNEYS
NUCLEI
ODD-EVEN NUCLEI
ORGANS
RADIOISOTOPE SCANNING
RADIOISOTOPES
REVIEWS
SCINTISCANNING
SENSITIVITY ANALYSIS
TECHNETIUM 99
TECHNETIUM ISOTOPES
UROGENITAL SYSTEM DISEASES
YEARS LIVING RADIOISOTOPES