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Tthe value of dynamic renal scintigraphy 99m-Tc MAG3 in detection of focal renal lesions

The potential of dynamic scintigraphy 99m-Tc MAG3 in children with urinary tract infection (UTI) besides assessment of differential renal function can be useful in the detection of focal parenchymal abnormalities. In order to assess the value of 99m-Tc MAG3 in detection of parenchymal lesions, 49 pts (6 boys and 41 girls), aged 0.5 to 12.8 years (mean 4.5 years) were prospectively investigated after the first febrile UTI. The selection criteria were: dilated reflux in 35 pts, non-dilated reflux in 4 and parenchymal changes (by US or IVU) in 7 pts. The parenchymal abnormalities detected on 99m-Tc MAG3 were compared with 99m-Tc DMSA scintigraphy in 18 pts done within 24 hr to 3 months. The comparison consisted of image analysis (classified as normal and abnormal) and split renal function (SRF) expressed as percentage function of left kidney. Study pts were divided in three groups according to results of SRF: group 1 (normal 45-55%), group 2 (slightly reduced <45%) and group 3 (reduced <40%). Comparison of image analysis considering 99m-Tc DMSA as reference method disclosed sensitivity of 83% and specificity of 80% with significant correlation between overall renal function (r=0.97) and for SRF (r=0.94). Initial 99m-Tc MAG3 images were abnormal in 21% (group 2 and 3). Follow-up 99m-Tc MAG3 images done after 2 to 6 years were abnormal in 26% of pts with reduced SRF (<45%) in 40%. Significant deterioration on second 99m-Tc MAG3 investigation in 19% of pts was possible due to new episodes of pyelonephritis in most pts. Conclusion: Dynamic scintigraphy with 99m-Tc MAG3 in clinical settings allows accurate assessment of differential renal function and has a high probability of detecting focal lesions in children with urinary infection.

kidney;children;urinary tract infection;focal parenchymal lesions;dynamic scintigraphy;MAG3;DMSA

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