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Childhood acute pyelonephritis: comparison of power Doppler sonography and Tc-DMSA scintigraphy.

Stogianni A, Nikolopoulos P, Oikonomou I, Gatzola M, Balaris V, Farmakiotis D, Dimitriadis A

Department of Radiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

BACKGROUND: Tc 99m DMSA scintigraphy is regarded as the gold standard for the detection and localization of acute pyelonephritis (APN) in children. Power Doppler sonography (PD US) is a radiation-free and cost-effective technique that could be useful in the diagnosis of APN in children. OBJECTIVE: To compare the predictive value of PD US with DMSA scintigraphy in the diagnosis of APN in children. MATERIALS AND METHODS: A total of 74 neonates and children with clinical findings consistent with possible upper urinary tract infection were evaluated with PD US and DMSA scintigraphy. Children with anatomic (grey-scale) abnormalities were excluded. A total of 147 kidneys were examined within the first 48 h after the onset of symptoms. Each kidney was divided into three zones (upper, middle, and lower third). RESULTS: APN was diagnosed by PD US in 46 kidneys. Sensitivity and specificity for detecting APN using DMSA scintigraphy as the reference standard were 73.8% and 85.7%, respectively. There was good agreement between PD US and DMSA scintigraphy in the localization of lesions. CONCLUSION: In clinically suspected APN, PD US has acceptable specificity and sensitivity, if performed within the first 48 h and could be helpful in neonates and children under 3 months of age in whom the use of scintigraphy is generally discouraged.

Published 13 June 2007 in Pediatr Radiol, 37(7): 685-90.
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