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Renal Fibrosis: Prediction from Acute Pyelonephritis Focus Volume Measured at ^99mTc Dimercaptosuccinic Acid SPECT¹

¹ From the Department of Pediatrics and Institute of Clinical Medical Sciences (Y.Y.C.), Public Health (S.T.W.), Physiology (M.J.T.), and Nuclear Medicine (B.F.L., N.T.C.), National Cheng Kung University Medical Center and College of Medicine, 138 Sheng-Li Rd, Tainan, Taiwan 704, Republic of China. Received December 13, 2000; revision requested January 16, 2001; revision received April 2; accepted April 9. Supported in part by grants from the National Science Council, Republic of China (NSC 88-2314-B-006-071 and 87-2314-B-006-001). Address correspondence to N.T.C. (e-mail: ntchiu@mail.ncku.edu.tw).

PURPOSE: To evaluate whether acute pyelonephritis lesion volume derived from acute technetium 99m (^99mTc) dimercaptosuccinic acid (DMSA) renal single photon emission computed tomographic (SPECT) images is predictive of the development of subsequent renal fibrosis.

MATERIALS AND METHODS: Children with acute pyelonephritis underwent ^99mTc DMSA renal SPECT during acute infection and 6–10 months later. At quantitative analysis, the volume of photopenic lesions and the ratio of radioactivity in the photopenic lesion to that in normal renal tissue were calculated. Sensitivity, specificity, and positive and negative predictive values were determined.

RESULTS: Sixty-nine acute pyelonephritis foci in 44 children were analyzed. Thirty-seven (54%) of these lesions were normal on follow-up renal scans, while 32 (46%) developed scars. Significant differences in the photopenic lesion volume were found between the two groups (P < .001). When photopenic lesion volume indicated a positive diagnosis (4.6-cm³ lesion volume), sensitivity, specificity, positive predictive, and negative predictive values were 96.7%, 92.3%, 90.6%, and 97.3%, respectively.

CONCLUSION: Quantitative analysis of acute DMSA renal SPECT findings is valuable in predicting renal fibrosis. The volume of an acute pyelonephritis lesion is useful in predicting the development of fibrosis.

Index terms: Kidney, infection, 81.2121 • Kidney, SPECT, 81.12162 • Nephritis, 81.2121 • Single photon emission computed tomography (SPECT), in infants and children, 81.12162

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