Efficacy of Cyclic Voiding Cystourethrography in Detection of Vesicoureteral Reflux in Young Children

PURPOSE: To evaluate the efficacy of cyclic voiding cystourethrography (VCUG) for the detection of vesicoureteral reflux (VUR) in young children. MATERIALS AND METHODS: Two cycles of cyclic VCUG were performed in 119 kidney-ureter units (KUUs) of 60 children (mean age; 9 months, range; 5 days-2 years). Spot radiographs and fluoroscopic-image captures were obtained. We analyzed the presence of VUR and the grade of VUR according to the standards of the international grading system. We recorded the amount of total contrast material on each cycle and the total fluoroscopic time. RESULTS: VUR was present in 21 (17.6%) KUUs of 13 (21.7%) children. On the first and second cycle, the reflux occurred in 9 (15.0%) children and 13 (12.6%) KUUs. In one hundred-four KUUs of 51 children whose VCUG results were negative on the first cycle, the reflux occurred in 4 (7.8%) children and 6 (5.8%) KUUs during the second cycle. The grading of the reflux was upgraded during a second cycle in one case. A new detection and upgrade of VUR by the second cycle was observed in 5 (9.8%) children and 7 (6.7%) KUUs. In 4 KUUs (53%) of these 7 KUUs, the VUR was higher than grade II. The mean amounts of contrast solution were 28 cc (range; 5-100 cc) on the first cycle and 39 cc (range; 10-100 cc) on the second cycle. The mean of the total fluoroscopic time was 147 seconds (range; 59-338 seconds). CONCLUSION: Cyclic VCUG can enhance the ability of the method to detect and grade VUR in children under 2 years of age.

Which are Risk Factors developing Renal Cortical Defects on 99 mTc - DMSA Scintigraphy in Children with Acute Urinary Tract Infections?

PURPOSE: To determine (1) the relationship between the cortical defects seen on 99 mTc-DMSA renal scans and age, and (2) the presence and degree of vesicoureteral reflux, and then to depict the risk factors for cortical defects in children with acute urinary tract infection (UTI). Furthermore, to assess the diagnostic value of VCUG in predicting a defect on 99 mTc-DMSA renal scans. MATERIALS AND METHODS: We studied 134 kidneys in 67 children aged 15 days-10 years (M:F=39:28) in whom symptomatic UTI was present. In all these children, both DMSA renal scans and voiding cystourethrography (VCUG) were performed. Scanning took place within 7 days of diagnosis and VCUG was performed after one month of diagnosis. Scintigraphic findings were graded according to the extent and number of cortical defects. We evaluated the relationships between the cortical defects seen on DMSA scans and age, and the grade of vesicoureteral reflux. The diagnostic value of VCUG in predicting cortical defects was analysed. Results: The prevalence of cortical defects was greater in patients older than two years (38/54, 70%) than in those aged less than two (38/80, 48%). The frequency of cortical defects was related to vesicoureteral reflux (p or =2yrs) at the time of acute UTI, and high grade of vesicoureteral reflux. The specificity of VCUG in predicting cortical defects is relatively high but the sensitivitiy is low, and a significant proportion of cortical defects therefore occurred in the absence of vesicoureteral reflux.

Imaging Findings of Xanthogra nulomatous Pyelonephritis

PURPOSE: To define the imaging patterns of xanthogranulomatous pyelonephritis (XGP). MATERIALS AND METHODS: The demographic, clinical, and imaging findings of 21 cases of pathologically proven XGP in 20 patients (bilateral in one) were evaluated. The findings of ultrasonography and CT were retrospec-tively evaluated with regard to distribution and extent of the disease, kidney size, the presence of calculi, hy-dronephrosis, and renal function. The findings were assessed by two radiologists, who established a consen-sus. Imaging and pathologic findings were compared. RESULTS: Sixteen of the 20 patients were female, and 19 were adults. Their age ranged from 3 to 61 (mean, 45) years. In all patients except one, the disease was unilateral (right: left=13:16). In one patient, XGP was bilater-al, and there were thus 21 cases. Seventeen (81%) of these were diffuse, and four (19%) were focal; extrarenal extension occurred in 13 cases (62%), among which ipsilateral pleural effusion was noted in two. The kidney was enlarged diffusely in 12 cases (57%), and focally in three (14%); urinary calculi were present in 16 cases (76%), with staghorn calculi in four of these; and hydronephrosis occurred in 17 (81%). Impairment of ipsilat-eral renal function was noted in 13 cases (62%). Clinical findings of inflammation such as fever, pyuria, bac-teriuria, or leucocytosis were noted in all patients. CONCLUSION: In addition to nephromegaly, renal function impairment, and urinary obstruction due to calculi, which are typical features of XGP, the condition may also show variable imaging findings. If the images ob-tained in the case of a middle-aged woman with clinical findings of urinary infection are atypical, we believe that XGP should be included in the differential diagnosis.