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proLékaře.cz / Journals / Nuclear Medicine / 2019 - 2

Detection of an acute pyelonephritis in children – a value of imaging methods

Czech version

Authors: Alice Bosáková 1;  Michal Hladík 1;  Radim Kočvara 2;  Zdeněk Doležel 3
Authors‘ workplace: Klinika dětského lékařství, Fakultní nemocnice Ostrava 1;  Urologická klinika, Všeobecná fakultní nemocnice Praha 2 2;  Pediatrická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice Brno, ČR 3
Published in: NuklMed 2019;8:22-28
Category: Review Article

Overview

The aim of this article is to give an overview of imaging methods involved in the diagnosis of acute pyelonephritis and to present possible novel perspectives in accuracy in imaging inflammatory changes of kidneys. Urinary tract infections (UTI) are the second most common childhood disease after inflammatory upper and lower respiratory tract illness. Acute pyelonephritis (APN) is defined by clinical and laboratory characteristics: fever above 38 °C, elevated inflammatory parameters (C-reactive protein, white blood cell count), elevated leukocyte count in urine and positive urine culture. Currently, imaging methods – ultrasound (USG), static renal scintigraphy (DMSA) and magnetic resonance imaging (MRI) – are also used to diagnose inflammatory changes and scars in the kidney parenchyma at present.  DMSA scans were found to be more sensitive than USG and have been accepted as a gold standard method for demonstrating acute renal parenchymal inflammatory lesions in the diagnosis of febrile UTI. Gadolinium-enhanced MRI has been found to be reliable in detection of acute pyelonephritic lesions in comparison with DMSA and can discriminate acute pyelonephritis and chronic scarring. In recent prospective study, comparing DMSA and diffusion-weighted magnetic resonance imaging (DWI) in children > 3 years of age with acute pyelonephritis the DWI confirmed acute inflammatory changes in all 31 patients (100 % percent) mostly unilateral, and the DMSA detected inflammatory lesions in 22 children (71 %). The DWI examination was performed without contrast agent and without general anesthesia. Further studies are required to use DWI for selection of patients at risk, particularly young children.

Keywords:

acute pyelonephritis – ultrasound – diffusion-weighted magnetic resonance imaging (DWI) – static renal scintigraphy (DMSA)

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Nuclear Medicine

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2019 Issue 2
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