Unenhanced MRI as an Alternative to 99m Tc-Labeled Dimercaptosuccinic Acid Scintigraphy in the Detection of Pediatric Renal Scarring.

Autor:	Freeman CW; 1 Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA., Altes TA; 2 Department of Radiology, University of Missouri Health System, One Hospital Dr, Columbia, MO 65212., Rehm PK; 3 Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA., de Lange EE; 3 Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA., Lancaster L; 3 Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA., Mugler JP 3rd; 3 Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA., Patrie JT; 4 Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA., Corbett S; 5 Department of Urology, University of Virginia Health System, Charlottesville, VA., Leiva-Salinas C; 2 Department of Radiology, University of Missouri Health System, One Hospital Dr, Columbia, MO 65212.; 3 Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA., Flors L; 2 Department of Radiology, University of Missouri Health System, One Hospital Dr, Columbia, MO 65212.; 3 Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA.
Jazyk:	angličtina
Zdroj:	AJR. American journal of roentgenology [AJR Am J Roentgenol] 2018 Apr; Vol. 210 (4), pp. 869-875. Date of Electronic Publication: 2018 Feb 15.
DOI:	10.2214/AJR.17.18379
Abstrakt:	Objective: The purpose of this study was to determine whether unenhanced MRI without sedation is a feasible substitute for dimercaptosuccinic acid (DMSA) scintigraphy in the detection of renal scars in pediatric patients. Subjects and Methods: Patients scheduled for 99m Tc-labeled DMSA scintigraphy for assessment of possible renal scars were recruited to undergo unenhanced MRI (free-breathing fat-suppressed T2-weighted single-shot turbo spin-echo and T1-weighted gradient-echo imaging, 13 minutes' total imaging time). Scintigraphic and MRI studies were evaluated by two independent blinded specialty-based radiologists. For each imaging examination, readers identified scars in upper, middle, and lower kidney zones and rated their diagnostic confidence and the quality of each study. The scintigraphic readers' consensus score opinion for the presence of scars was considered the reference standard. Results: DMSA scintigraphy showed scarring in 19 of the 78 (24.4%) evaluated zones and MRI in 18 of the 78 (23.1%). The two MRI readers found mean sensitivities of 94.7% and 89.5%, identical specificities of 100%, and diagnostic accuracies of 98.7% and 97.4%. Interobserver agreement was 98.7% for MRI and 92.3% for DMSA scintigraphy. The MRI readers were significantly more confident in determining the absence rather than the presence of scars (p = 0.02). MRI readers were more likely to rate study quality as excellent (84.6%) than were the scintigraphic readers (57.7%) (p = 0.024). Conclusion: Unenhanced MRI has excellent sensitivity, specificity, diagnostic accuracy, and interobserver agreement for detecting renal scars in older children who do not need sedation. It may serve as a substitute modality, especially when DMSA is not available.
Databáze:	MEDLINE
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