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Acute Pyelonephritis: Comparison of Diagnosis with ^99mTc-DMSA SPECT, Spiral CT, MR Imaging, and Power Doppler US in an Experimental Pig Model¹

¹ From the Depts of Radiology (M.M., A.R.N.B., B.M.M., E.S.R., N.P.), Urology (H.G.P., J.S.P., H.G.R.), Pathology (R.C.), Neonatology (K.R.B.), and Research Institute (K.M.P.), Children’s National Medical Center and the George Washington Univ School of Medicine, 111 Michigan Ave NW, Washington, DC 20010. From the 1997 RSNA scientific assembly. Received Feb 1, 2000; revision requested Mar 30; final revision received Jul 24; accepted Jul 26. Supported in part by the Board of Lady Visitors and the Discovery Fund of Children’s National Medical Center, Society for Pediatric Radiology, and Society of Uroradiology. Address correspondence to M.M. (e-mail: mmajd@cnmc.org).

PURPOSE: To compare the sensitivity and specificity of technetium-99m dimercaptosuccinic acid (DMSA) single photon emission computed tomography (SPECT), spiral computed tomography (CT), magnetic resonance (MR) imaging, and power Doppler ultrasonography (US) for the detection and localization of acute pyelonephritis by using histopathologic findings as the standard of reference.

MATERIALS AND METHODS: Bilateral vesicoureteric reflux was surgically created in 35 piglets (70 kidneys). One week later, a liquid bacterial culture of Escherichia coli was injected into the bladder. Three days after induction of urinary infection, imaging studies were performed, and the kidneys were removed for histopathologic examination. SPECT images were obtained 2–3 hours after injection of ^99mTc-DMSA. Transverse and coronal MR images were obtained with gadolinium-enhanced fast inversion recovery. Transverse CT images were obtained before and after injection of contrast agent. Power Doppler US was performed in longitudinal, transverse, and coronal planes. Each kidney was divided into three zones for correlation of findings.

RESULTS: Histopathologic examination revealed pyelonephritis in 102 zones in 38 kidneys. Sensitivity and specificity for detecting pyelonephritis in the kidneys were 92.1% and 93.8% for SPECT, 89.5% and 87.5% for MR imaging, 86.8% and 87.5% for CT, and 74.3% and 56.7% for US. Sensitivity and specificity for detecting pyelonephritis in the zones were 94.1% and 95.4% for SPECT, 91.2% and 92.6% for MR imaging, 88.2% and 93.5% for CT, and 56.6% and 81.4% for US. The pairwise comparison of these modalities showed no statistically significant difference among them except for US.

CONCLUSION: ^99mTc-DMSA SPECT, spiral CT, and MR imaging appear to be equally sensitive and reliable for the detection of acute pyelonephritis; power Doppler US is significantly less accurate.

Index terms: Animals • Kidney, CT, 81.12114, 81.12115 • Kidney, MR, 81.121411, 81.121412, 81.121413, 81.12143 • Kidney, SPECT, 81.12171 • Kidney, US, 81.12984 • Nephritis, 81.212 • Ultrasound (US), comparative studies

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