Validity of 99mTc-dimercaptosuccinic acid scan for an assessment of uropathy in children
Authors
이현수
Issue Date
1989
Description
의학과/석사
Abstract
[한글]
소아요로 감염증에 대한 방사선 검사의 일차적 목적은 지속성 혹은 재발성 요로 감염에 선행되는 선천성 기헝과 신반흔 및 기능적 이상등을 찾아내는데 있다.
종전에는 IVP가 신반흔을 평가하는데 우선적으로 시행해야 할 검사로 인식되어 왔으나, IVP는 nephrographic phase가 짧고 신장의 모양을 정확히 보기위해서는 신변지방이 반드시 있어야 할 뿐더러 장내가스나 골구조에 의해 방해되는 문제가 있으며, 수술후 각각의
신기능평가에 있어서도 ureteral catheterization과 같은 어렵고 위험성이 수반되는 방법이 채택되어 왔다. 그러나 손상받은 신장을 조기에 선별하고, 안전하고 정확한 신기능 판독을 가능케하는 99mTc-DMSA scan이 1970년대부터 대두되기 시작하였다. 그러므로 소아요로질환 평가에 있어서, 99mTc-DMSA scan의 의의를 알아보고자 본 연구를 실시하여 다음과 같은 결론을 얻었다.
그러므로 99mTc-DMSA는 선택적으로 신피질에 측적되어 각각의 신기능을 평가하는데 유용한 검사방법이며, 신반흔 검출을 위해 단순요로감염 환아에 있어 우선적으로 실시되어야 할 검사방법으로 사료된다. 또한 IVP, 복부초음파 및 VCUG에 비해 신기능평가를 정확히 할 수 있어 치료방향의 설정에도 도움을 주는 검사방법이며 수술후 남아있는 신기능평가에도 유용한 검사방법으로 사료된다.
[영문]
99m Technetium dimercaptosuccinic acid(DMSA) is a new renal scanning agent provides a good quality of renal image as a result of preferential cortical accumulation.
The presence of scarring is the important determinant in the selection of those at risk of progressive damage. Traditionally the IVP has been the preferred study to evaluate pyelonephritic scarring. However the IVP has some limitations, including the short nephrographic phase, the need for adequate perirenal fat for resolution of renal outlines and most importantly, interfere from bowel gas. These problems are particularly important in children, in whom poor cooperation, limited bowel prepartation and abnormal kidneys are more common. Also 99mTc-DMSA scan may
replace the conditional split renal function study in which traumatic procedures, such as cystoscopy and ureteral catheterization.
Therefore the author has performed this study to evaluate the lesions for performing the scan as the initial examination in children with urinary tract infection and validity of 99mTc-DMSA uptake for an assessment of uropathy.
99mTc-DMSA scan was performed in 39 patients among 171 patients diagnosed UTI at pediatric department of Severance Hospital, Yonsei University. College of Medicine from March 1986 to July 1988.
The results were as follows :
1) The average value of 99mTc-DMSA uptake of each kidney in healthy control group was 38.4±3.4% for the right kidney and 41.8±3.4% for the left kidney. The average value of total 99mTc-DMSA uptake was 39.2±8.2%.
2) In cases of unilateral uropathy with a contralateral healthy kidney, the 97mTc DMSA uptake from the healthy side increased when compared to the normal healthy control group but the pathologic 99mTc-DMSA uptake decreased when compared to the
normal healthy control group.
3) In cases of bilateral uropathies, the 99mTc-DMSA uptake of each kidney was decreased compared to the normal healthy control group.
4) In 20 simple UTI cases, cases of abnormal findings including renal scar or focal defects on IVP and sonogram was 5(25%) and 4(20%) respectively. But those in 99mTc-DMSA scan was 12(60%).
5) A sensitivity of 0.53 and specificity of 0.42 for IVP, compared with a specificity of 0.88 and sensitivity of 0.83 for 99mTc-DMSA scan in 20 simple UTI cases.
6) In cases of UTI with obstructive uropathy, 99mTc-DMSA scan was an ideal method in detection of renal scarring and evaluation of renal function, compared to IVP, sonogram and VCUG and this increased sensitivity and specificity may affect clinical management.
7) 99mTc-DMSA scan was an reliable method in an assessment of postoperative renal function compared to IVP.
8) Preoperative uptake of 99mTc-DMSA was compared to early postoperative unilateral Ccr, measured 2 & 3 days postoperatively by urine collection from the nephrostomy tube and expressed as a percentage of the total Ccr (Urine from the contralateral kidney was obtained normally). An excellent correlation was found,
the correlation coefficient being 0.79(y=0.70x + 4.58).
We concluded that 99mTc-DMSA made a feasible quantitation assessment of seperate kidney function and had a higher sensitivity and specificity in the detection of pyelohephritic scarring compared to IVP. therefore this increased sensitivity and specificity may affect clinical management.