Uroradiologic evaluation of children with urinary tract infection: are both ultrasonograpy and renal cortical scintigraphy necessary?

Abstract

Objective: To compare the findings of renal ultrasonography (RUS), 99mTc glucoheptonate renal scan (GHS), and voiding cystourethrography (VCUG) in children with urinary tract infection.

Design: Prospective, masked, clinical study.

Setting: Single center, multidisciplinary, inpatients.

Patients: Consecutive cases (N = 50) of children aged 2 months to 15 years (8 boys, 42 girls) with pyelonephritis in whom uroradiologic investigation was indicated.

Measurements and main results: All patients underwent GHS, 48 had RUS, and 2 had intravenous pyelography. All but one of the patients had a VCUG. Fifteen children were found to have vesicoureteral reflux (6 unilaterally, 9 bilaterally). Of 96 kidneys evaluated by both GHS and RUS, 53 were abnormal by GHS versus 28 by RUS (p < 0.001). Findings of both GHS and US were normal in 36 kidneys and abnormal in 21 kidneys. In 32 kidneys only GHS showed abnormalities. In 7 kidneys only RUS showed abnormalities; 5 of them had mild to moderate pelvic dilation caused by reflux, which was confirmed in all 5 by VCUG. The VCUG demonstrated reflux in another four units with normal GHS and RUS findings. All combined, GHS and VCUG detected 62 of 64 abnormal renal units (96.9%). In the other two cases, RUS showed only focal hyperechogenicity of questionable importance.

Conclusion: In the event that one elects to use GHS for the uroradiologic evaluation of children with urinary tract infection, it can be supplemented by VCUG alone, and RUS can be saved for special cases.