NEW YORK (Reuters Health) – The accuracy of dimercaptosuccinic acid (DMSA) scintigraphy for detecting vesicoureteral reflux (VUR) in young children with urinary tract infections is such that it cannot be considered an alternative to voiding cystourethrography, Greek clinicians report in the September issue of Pediatrics.

“Several published reports suggested that a normal DMSA scan obviates the performance of voiding cystourethrography” in evaluating young children for VUR after a first febrile UTI, explain Dr. Sotirios Fouzas and colleagues at the University Hospital of Patras.

To look into this, the investigators analyzed data on 296 children no older than 24months (median 5 months) who were included in the hospital’s prospective UTI registry. Cyclic voiding cystourethrography identified dilating VUR (i.e., grade 3-5) in 46 children and severe VUR (grades 4 or 5) in 25 of them.

Children with an abnormal DMSA scan had an odds ratio of 4.36 for dilating VUR and 5.50 for severe VUR. When combined with an abnormal renal ultrasound exam, these odds ratios were 3.60 and 6.32, respectively.

However, “Four children had severe VUR despite normal findings on renal ultrasonography and/or acute DMSA scintigraphy,” Dr. Fouzas and colleagues report.

The sensitivity and specificity of the combination of ultrasound and DMSA were 73.9% and 56.0% in identifying children with dilating VUR, and 84.0% and 54.6% for detecting severe VUR.

“Thus, we cannot endorse acute DMSA scan as a replacement for voiding cystourethrography in primary evaluation of young children with UTI,” the investigators conclude.

Reference:

DMSA Scan for Revealing Vesicoureteral Reflux in Young Children With Urinary Tract Infection

Pediatrics 2010;126:e.