technetium-tc-99m-gluceptate and Pyelonephritis

Comparative clinical studies have shown renal cortical scintigraphy, using technetium-99m (99mTc)-labeled glucoheptonate or dimercaptosuccinic acid (DMSA), to be significantly more sensitive than either intravenous pyelography or renal sonography in the diagnosis of acute pyelonephritis. However, due to uncertainties about the diagnostic accuracy of the clinical and laboratory parameters used in these studies, true sensitivity of renal cortical scintigraphy was unknown. Therefore, we evaluated the accuracy of [99mTc]DMSA scintigraphy in the diagnosis of experimentally induced acute pyelonephritis in piglets using strict histopathologic criteria as the standard of reference. The sensitivity and specificity of the DMSA scan for the diagnosis of acute pyelonephritis were 91% and 99%, respectively, with an overall 97% agreement between the scintigraphic and histopathologic findings. Based on the results of this experimental study, we used the [99mTc]DMSA scan as the standard of reference for the diagnosis of acute pyelonephritis, and conducted a prospective clinical study of 94 children hospitalized with the diagnosis of acute febrile urinary tract infection (UTI). The aims of this study were (1) to determine the relationship among vesicoureteral reflux, P-fimbriated Escherichia coli, acute pyelonephritis, and renal scarring, and (2) to evaluate the diagnostic reliability of the clinical and laboratory parameters commonly used in the diagnosis of acute pyelonephritis. We documented acute pyelonephritis in 62 (66%) of 94 patients. Vesicoureteral reflux was demonstrated in 29 (31%) of the total group and in only 23 (37%) of 62 patients with acute pyelonephritis. The prevalence of P-fimbriae in the E coli isolates was 64% in the patients with acute pyelonephritis and 78% in those with a normal DMSA scan. Even in patients without reflux, P-fimbriae were found in 71% of isolates from the patients with acute pyelonephritis and in 75% of those with a normal renal scan. Follow-up DMSA scans were obtained in 33 patients with acute pyelonephritis in 38 kidneys. We found complete resolution of the acute inflammatory changes in 58% of the involved kidneys and renal scarring in the remaining 42%, including 40% of the kidneys associated with reflux and 43% of those without reflux.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Acute Disease; Animals; Humans; Kidney Cortex; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Succimer; Sugar Acids; Technetium Tc 99m Dimercaptosuccinic Acid; Vesico-Ureteral Reflux

There is controversy regarding the role of radiological imaging for urinary tract infection (UTI). The "gold standard" has been the intravenous pyelogram (IVP). Yet, the IVP has a very limited value with only about 25% of children with pyelonephritis demonstrating abnormalities. Ultrasound (US) has recently been advocated as a replacement for the poorly sensitive and poorly specific IVP. However, comparative studies between US and IVP indicate only an equivalent sensitivity and specificity. Cortical scintigraphy with Technetium-99m glucoheptonate (99mTc GH) or 99mTc dimercaptosuccinic acid (99mTc DMSA) has also been advocated as a means of differentiating parenchymal (pyelonephritis) from nonparenchymal (lower UTI) involvement in UTI. The clinical presentation may be misleading especially in the infant and child in whom an elevated temperature, flank pain, shaking chills, or an elevated sedimentation rate are often lacking. The clinician attempts to localize the site of infection for it has a direct bearing upon the therapy. A collecting system infection can often be eradicated with a single oral dose of an appropriate antibiotic, whereas renal parenchymal involvement requires IV therapy for an extended interval. Cortical scintigraphy can localize the site of infection with a high degree of accuracy. Recent studies report a sensitivity of 86% and specificity of 81% of pyelonephritis. This is in contrast to the IVP with a sensitivity of only 24% and US with a sensitivity of only 42%. The scintigraphic appearance of parenchymal infection of the kidney is a spectrum of minimal to gross defects reflecting the degree of histologic involvement that spans from a mild infection to frank abscess. Cortical scintigraphy can be used to monitor the evolution of scarring following infection. Cortical scintigraphy with 99mTc DMSA or 99mTc GH is the method of choice for the initial evaluation of UTI. Not only does it have a very high sensitivity and specificity for differentiating parenchymal from collecting system disease, but it also provides an accurate quantitative measurement of function and in combination with radioiodinated orthoiodohippurate renography and Lasix (furosemide; Abbott Laboratories, North Chicago) diuresis will also differentiate significant obstruction from stasis. The use of radionuclide techniques opens new vistas for the investigation of UTI. Cortical scintigraphy should become the gold standard by which other technologies, therapy, and theoretic

Topics: Child; Child, Preschool; Humans; Infant; Kidney Cortex; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Sugar Acids; Technetium; Urinary Tract Infections

This article describes the role of nuclear medicine in the evaluation of the genitourinary tract. The technical aspects of radionuclide imaging (radiopharmaceuticals, radiation dosimetry, instrumentation, and method) are briefly presented, and each of the indications for renal scintigraphy--including the evaluation of differential renal function, hypertension, obstruction, renal transplants, masses, trauma, congenital anomalies, vesicoureteral reflux, and infection--are discussed. The relative advantages and disadvantages of radionuclide imaging with respect to alternative radiographic examinations (such as intravenous urography, ultrasonography, CT, angiography, and magnetic resonance imaging) are emphasized wherever applicable.

Topics: Graft Rejection; Humans; Hypertension, Renovascular; Iodohippuric Acid; Kidney; Kidney Function Tests; Kidney Neoplasms; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Male; Organotechnetium Compounds; Pentetic Acid; Postoperative Complications; Pyelonephritis; Radioisotope Renography; Spermatic Cord Torsion; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate; Ureteral Obstruction; Urinary Tract; Vesico-Ureteral Reflux

The diagnostic value of renal scintiscans in patients with acute or chronic renal failure has not been emphasized other than for the estimation of renal size. 131I OIH, 67gallium, 99mTcDTPA, glucoheptonate and DMSA all may be valuable in a variety of specific settings. Acute renal failure due to acute tubular necrosis, hepatorenal syndrome, acute interstitial nephritis, cortical necrosis, renal artery embolism, or acute pyelonephritis may be recognized. Data useful in the diagnosis and management of the patient with obstructive or reflux nephropathy may be obtained. Radionuclide studies in patients with chronic renal failure may help make apparent such causes as renal artery stenosis, chronic pyelonephritis or lymphomatous kidney infiltration. Future correlation of scanning results with renal pathology promises to further expand nuclear medicine's utility in the noninvasive diagnosis of renal disease.

Topics: Acute Kidney Injury; Adult; Aged; Embolism; Female; Gallium Radioisotopes; Humans; Iodine Radioisotopes; Iodohippuric Acid; Kidney Failure, Chronic; Kidney Neoplasms; Male; Middle Aged; Nephritis, Interstitial; Organotechnetium Compounds; Pentetic Acid; Pyelonephritis; Radionuclide Imaging; Renal Artery Obstruction; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Technetium Tc 99m Pentetate

We attempted to differentiate pyelonephritis, defined as upper urinary tract parenchymal infection, from fever due to other sources in patients with spinal cord injury by radioisotope renal scintigraphy.. A total of 13 consecutive spinal cord injury patients 21 to 54 years old (level of injury C4 to cauda equina) was hospitalized with urosepsis. The diagnosis was based on medical history, physical examination and laboratory evaluation, including blood, urine, sputum and wound fluid culture and sensitivity, and a 99mtechnetium glucoheptonate renal scan for pyelonephritis. Renal scan results were compared to 1 or more of several studies performed in each case, including ultrasonography, excretory urography and axial computerized tomography.. Glucoheptonate renal scintigraphy accurately diagnosed pyelonephritis in all 7 patients with a scintigraphic B lesion. In 2 patients with a C lesion on scintigraphy, representing a cortical scar, other sources of sepsis were identified. In the 4 patients with negative renal scans pyrexia was attributed to active decubitus wound infection and osteomyelitis. Positive and negative predictive values of renal scanning were each 100%.. Nuclear medicine renal scanning is a valuable adjunct in the evaluation of sepsis and presumed urosepsis in the spinal cord injury population.

Topics: Adult; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Organotechnetium Compounds; Pyelonephritis; Radioisotope Renography; Spinal Cord Injuries; Sugar Acids; Urinary Tract Infections

To compare gadolinium-enhanced inversion-recovery magnetic resonance (MR) imaging with renal cortical scintigraphy in the diagnosis of childhood pyelonephritis.. Thirty-seven patients with fever-producing urinary tract infection underwent gadolinium-enhanced inversion-recovery MR imaging and technetium-99m renal cortical scintigraphy. Each study was read in double-blind fashion by two radiologists. The kidney was divided into three zones, and each was graded as positive, equivocal, or negative for pyelonephritis.. Seventy kidneys (210 zones) were imaged. Twenty-six kidneys (54 zones) had evidence of pyelonephritis at both MR imaging and scintigraphy. Twenty-four kidneys (100 zones) were negative on both studies. Twelve kidneys (42 zones) were positive at MR imaging but negative at scintigraphy, and four kidneys (seven zones) were negative at MR imaging but positive at scintigraphy. The results of MR imaging for pyelonephritis were not equivalent to the results of scintigraphy (P = .001 for renal zones). The proportion of positive agreement between readers for the presence of pyelonephritis was 0.85 and 0.57 for MR imaging and scintigraphy, respectively. The proportion of negative agreement was 0.88 and 0.80 for MR imaging and scintigraphy, respectively.. Gadolinium-enhanced inversion-recovery MR imaging enabled detection of more pyelonephritic lesions than did renal cortical scintigraphy and had superior interobserver agreement.

Topics: Adolescent; Chi-Square Distribution; Child; Child, Preschool; Contrast Media; Double-Blind Method; Fever; Gadolinium DTPA; Humans; Hypnotics and Sedatives; Image Enhancement; Image Processing, Computer-Assisted; Kidney Cortex; Magnetic Resonance Imaging; Observer Variation; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Radiopharmaceuticals; Sensitivity and Specificity; Sugar Acids; Technetium Tc 99m Dimercaptosuccinic Acid

The purpose of this study was to determine whether 99mTc-mercaptotriacetylglycine (MAG3) can substitute for 99mTc-glucoheptonate (GH) in the detection of pyelonephritis.. One hundred thirty renal scintigraphies were evaluated retrospectively in 38 children (21% boys, 79% girls; age range 1 mo-21 yr; mean age 7.2 yr) referred for evaluation during an acute clinical urinary tract infection and for follow-up studies. Twelve topographical regions were designated on each kidney. Each area was graded for severity of decreased radionuclide localization: mild (Grade 1), moderate (Grade 2) or marked (Grade 3). Early posterior views of MAG3 studies were compared to delayed posterior GH images. In all patients, both studies were performed on the same day.. Eighty-two studies were performed during an acute clinical infection and 48 were performed as follow-up. Seventy-seven percent of the studies had focal cortical lesions. Of all the cortical lesions identified by GH, MAG3 detected 74% (match lesions). A comparable percentage of lesions was identified in each region by both studies. GH scintigraphy detected 261 lesions (63 Grade 1, 149 Grade 2 and 49 Grade 3), and MAG3 detected 201 lesions (37 Grade 1, 117 Grade 2 and 47 Grade 3). MAG3 was unable to recognize 60 lesions identified by GH studies in 11 patients (mismatch lesions). Of these, 41% (26 of 63) were Grade 1, 21% (32 of 149) were Grade 2 and 4% (2 of 49) were Grade 3. In three cases, MAG3 identified lesions not seen by GH (reverse mismatch); all had acute symptomatic infection.. These data document that MAG3 in the early phase of the study (1-2 min) can detect Grade 2 to Grade 3 cortical lesions in patients with pyelonephritis, but it is less effective in detecting Grade 1 lesions.

Topics: Child; Female; Humans; Kidney Cortex; Male; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sugar Acids; Technetium Tc 99m Mertiatide; Time Factors

Topics: Child; Humans; Kidney Cortex; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Radiopharmaceuticals; Sugar Acids; Technetium Tc 99m Dimercaptosuccinic Acid

Topics: Child; Child, Preschool; Diagnostic Imaging; Female; Humans; Infant; Male; Organotechnetium Compounds; Pyelonephritis; Radioisotope Renography; Succimer; Sugar Acids; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections; Vesico-Ureteral Reflux

Renal scintigraphy represents the optimal modality for the detection of renal scars. 99mTechnetium-glucoheptonate is rapidly accumulated by the kidney through glomerular filtration and active transport by renal tubular cells. This permits rapid visualization of the renal parenchyma in the early phase (1 to 3-minute images) and subsequent imaging of the collecting system and ureters. About 10 to 15 per cent of the injected activity remains in the kidney, labeling the cells of the proximal convoluted tubules (late phase or 1 to 2-hour images). The late phase has been used more commonly to assess renal parenchymal damage. Early and late phase glucoheptonate scanning was performed in 42 children as part of the evaluation of recurrent febrile urinary tract infections with or without a history of vesicoureteral reflux. Inter-observer reliability to interpret glucoheptonate scans was good (early, 83 per cent agreement and late, 93 per cent agreement). The ability of glucoheptonate scanning to detect renal scarring in children with febrile urinary tract infections was equivalent with the early or late phase of the study. In 6 patients renal scarring was detected on only the early phase scan and in 7 scarring was detected only in the late phase. Although the detection rates are equivalent the over-all detection of scarring is improved by using both phases. Therefore, the early phase of the glucoheptonate scan may be a valuable adjunct to conventional glucoheptonate scan methodology used for the detection of renal scarring in children with recurrent urinary tract infections.

Topics: Adolescent; Child; Child, Preschool; Cicatrix; Evaluation Studies as Topic; Humans; Infant; Kidney; Organotechnetium Compounds; Prospective Studies; Pyelonephritis; Radionuclide Imaging; Sugar Acids; Technetium; Urinary Tract Infections

A retrospective study was performed of 39 children at the Children's Memorial Hospital, Chicago, Illinois, who underwent technetium-99m glucoheptonate (99mTcGH) scintigraphy for evaluation of possible urinary tract infection. Clinical and laboratory criteria classified the children as having pyelonephritis, cystitis, or no urinary tract infection. Of 28 children classified as having pyelonephritis, 24 (86%) children had abnormalities on 99mTcGH scintigraphy. Only 8 of 19 (42%) renal ultrasound scans and 4 of 17 (24%) intravenous pyelography studies performed in these children demonstrated findings consistent with parenchymal disease. Only 9 of 19 (47%) cystograms demonstrated vesicoureteral reflux. Three children who underwent gallium-67 citrate scintigraphy had localization at the sites of focal defects with 99mTcGH scintigraphy. 99mTcGH scintigraphy is a sensitive and specific indicator of renal parenchymal involvement that helps localize urinary tract infection to the kidney.

Topics: Child; Child, Preschool; Cystitis; Female; Gallium Radioisotopes; Humans; Male; Organotechnetium Compounds; Pyelonephritis; Radionuclide Imaging; Retrospective Studies; Sugar Acids; Technetium; Urinary Tract Infections

Patients with acute pyelonephritis may present with a spectrum of clinical signs and symptoms. There are few noninvasive diagnostic studies, however, to confirm or exclude this diagnosis. A small number of patients, generally those with severe disease, will demonstrate radiographic changes on excretory urography, but the lack of sensitivity of the IVP in early, acute pyelonephritis is well documented. Several radionuclide techniques have been proposed to assist in the earlier detection of this clinical problem including imaging with Mercury-197 chlormerodrin, Gallium-67 citrate, Technetium-99m glucoheptonate. Technetium-99m DMSA, and, more recently, Indium-111 labeled white blood cells. The success of the renal cortical imaging agents as well as those which localize in infection are described in this report. There appears to be a complimentary role or the cortical imaging agents and the radiopharmaceuticals which localize in bacterial infection. Cortical agents offer the advantage of specific assessment of functioning renal tissue and a convenient, rapid method for following the response to treatment in a noninvasive manner. A pattern is described which may be diagnostic; correlation with Gallium-67 citrate of Indium-111 WBCs may increase the probability of infection as the cause for the cortical abnormality. The measurement of differential renal function using cortical agents provides additional information to assist the clinician in predicting the late effects of infection. Improved sensitivity and specificity, and a reproducible method for following the response to therapy in patients with acute pyelonephritis are the advantages of the techniques described.

Topics: Acute Disease; Adolescent; Adult; Bacterial Infections; Child; Child, Preschool; Female; Gallium Radioisotopes; Humans; Indium; Infant; Infant, Newborn; Leukocytes; Male; Middle Aged; Organotechnetium Compounds; Pyelonephritis; Radioisotopes; Succimer; Sugar Acids; Technetium; Technetium Tc 99m Dimercaptosuccinic Acid; Tomography, Emission-Computed