Accuracy of Early DMSA Scan for VUR in Young Children With Febrile UTI
OBJECTIVE: To evaluate the accuracy of an acute 99mTc-dimercaptosuccinic acid (DMSA) scan in predicting dilating vesicoureteral reflux (VUR) among young children with a febrile urinary tract infection (UTI).
METHODS: The medical records of children (≤2 years of age), presenting with febrile UTI between January 2000 and December 2011, were retrospectively reviewed.
RESULTS: A total of 523 children were included in this study, of whom 397 children (75.9%) had abnormal DMSA results and 178 children (34.0%) were identified as VUR on micturating cystourethrography (MCU). Among all the patients, the number of children with dilating VUR was 151 (28.9%). The rate of abnormal results on DMSA for the dilating VUR group was significantly higher than the rates for the non-VUR and low-grade VUR groups (P < .01). In the <6 months age group and ≥6 months age group, the sensitivities of DMSA in predicting dilating VUR were 96.15% and 100.0%, respectively, the negative predictive values were 97.26% and 100.0%, respectively, and the negative likelihood ratios were 0.0911 and 0.0000, respectively.
CONCLUSION For children ≤2 years of age with a febrile UTI, an acute DMSA scan is valuable in the exclusion of dilating VUR. The likelihood of the presence of dilating VUR on MCU is rather low when the result of DMSA is negative. DMSA should be conducted to assess the need for an MCU.
- CI —
- confidence interval
- DMSA —
- 99mTc-dimercaptosuccinic acid
- LR —
- likelihood ratio
- MCU —
- micturating cystourethrography
- UTI —
- urinary tract infection
- VUR —
- vesicoureteral reflux
- Accepted October 8, 2013.
- Copyright © 2014 by the American Academy of Pediatrics