Is it possible to avoid unnecessary voiding cystourethrography by performing acute Technetium-99m dimercaptosuccinic acid scintigraphy and renal ultrasound scanning after first febrile urinary tract infection in children?

Abstract

 Objective: To evaluate the predictive value of acute Technetium-99m dimercaptosuccinic acid scintigraphy (acute DMSA) and renal ultrasound scanning (US) for high-grade vesicoureteral reflex (VUR) in children with a first urinary tract infection (UTI).
 Materials and Methods: A retrospective analysis of the records of 19 children (14 boys and 5 girls) was performed. Acute DMSA and US were performed within7days from diagnosis, and voiding cysturethrography (VCUG) was performed within 2 months.
 Results: Of 19 children, high-grade VUR (III∼V) was diagnosed in 7 (37%). The detection rate of high-grade VUR by US alone was 28%. But combining acute DMSA and US, we found that the detection rate of high-grade VUR was 100%. If VCUG had been performed only in children with abnormal acute DMSA or US results, 6 VCUGs (32%) could have been avoided.
 Conclusion: VCUG is only indicated when abnormalities are apparent on either acute DMSA or US or both.