Sensitivity of Dimercaptosuccinic Acid(DMSA) Renal Scan in Children with Acute Pyelonephritis

PURPOSE: Accurate diagnosis of acute pyelonephritis(APN) using clinical and laboratory parameters is often difficult in children. Clinical and experimental studies have demonstrated that renal scarring can be prevented or diminished by early diagnosis and aggressive treatment of acute pyelonephritis. dimercaptosuccinic acid(DMSA) renal scan has been reported to be useful in children for confirmation of the diagnosis of acute pyelonephritis. An analysis was undertaken to correlate the clinical and laboratory manifestations of APN with the results of the DMSA renal scan in different age groups. METHODS: We determined the sensitivity of DMSA renal scan in febrile urinary tract infections(UTI) in two groups according to age:group I in less than 2 years; group II in older than 2 years. During the period March 2001 through September 2002, 67 children presented with febrile UTIs. All patients had DMSA renal scan done in the acute period, 55 had voiding cystourethrography(VCUG) and 66 had renal ultrasonogram(RUS) done. RESULTS: There were no significant difference between the two groups in DMSA renal scan (P>0.05). But, in group I sensitivity of DMSA renal scan was 47%; in group II sensitivity of DMSA renal scan was 70%. The grade of reflux correlated with a positive DMSA renal scan. Vesicoureteral reflux did not correlate with age. RUS did not correlate with a positive DMSA renal scan in any age group. Abnormality of RUS did not correlate with age. CONCLUSION: At present, we believe that DMSA renal scan is the prevailing method in differention of the APN. In addition, it is not invasive and less costly. Even though there is no statistical difference in the sensitivity of DMSA renal scan between young and older children, we can observe that in the younger group, the sensitivity of DMSA renal scan seemed to be lower(47%).

Comparison between Mammography, Ultrasonography and 99 mTc-MIBI Scintimammography in the Diagnosis of Breast Cancer

PURPOSE: To compare the feasibility of 9 9 mTc-MIBI scintimammography as a tumor localizing agent in breast lesions in comparison with that of mammography and ultrasonography, and to evaluate the efficacy of these three modalities. MATERIALS AND METHODS: Sixty-four breast lesions were classified as benign or malignant on the basis of sono-graphic and mammographic criteria and were further analyzed by means of 99mTc-MIBI scintimammography. The classifications thus obtained were compared with the biopsy findings, and in order to compare the three techniques, the sensitivity, specificity, accuracy, and negative and positive predictive values were calculated for each individual modality. RESULTS: Of 64 histologically proven lesions, 33 were malignant and 31 were benign. Sensitivities and specificities for malignancy were 86.2% and 64.5% for mammography, 87.9% and 76.7 % for sonography, and 78.8% and 74.2% for 99mTc-MIBI scintimammography. CONCLUSION: Mammography and ultrasonogrphy are reliable diagnostic modalities for the detection of breast cancer. 99mTc-MIBI scintimammography has a higher specificity than mammography and it may help to reduce unnecessary biopsies.