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Imaging strategies in pediatric urinary tract infection

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Abstract

This article is focused on the controversial topic of imaging strategies in pediatric urinary tract infection. A review of the recent literature illustrates the complementary roles of ultrasound, diagnostic radiology and nuclear medicine. The authors stress the key role of ultrasound which has recently been debated. The commonly associated vesicoureteric reflux has to be classified as congenital or secondary due to voiding dysfunction. A series of frequently asked questions are addressed in a second section. The proposed answers are not the product of a consensus but should rather be considered as proposals to enrich the ongoing debate concerning the evaluation of urinary tract infection in children.

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References

  1. Jodal U (1994) Urinary tract infections (UTI): significance, pathogenesis, clinical features and diagnosis. In: Postelthwaite RJ (ed) Clinical pediatric nephrology, 2nd edn. Butterworth-Heineman, Oxford, pp 151–159

    Google Scholar 

  2. Jodal U, Lindberg U (1999) Guidelines for management of children with UTI and VUR. Recommendations from a Swedish state of the art conference. Acta Paediatr 431:87–89

    Google Scholar 

  3. Hellerstein S (1995) Urinary tract infection: old and new concepts. Pediatr Clin N Am 42:1433–1457

    Google Scholar 

  4. Hoberman A, Charron M, Hickey RW, Baskin M, Kearney DH, Wald ER (2003) Imaging studies after a first febrile urinary tract infection in young children. N Engl J Med 348:195–202

    Article  PubMed  Google Scholar 

  5. Moorthy I, Joshi N, Cook JV, Warren M (2003) Antenatal hydronephrosis: negative predictive value of normal postnatal ultrasound: a 5-year study. Clin Radiol 58:964–970

    Google Scholar 

  6. Phan V, Traubici J, Hershenfield B, Stephens D, Rosenblum ND, Geary DF (2003) Vesicoureteral reflux in infants with isolated antenatal hydronephrosis. Pediatr Nephrol 18:1224–1228

    Article  PubMed  Google Scholar 

  7. Anderson NG, Wright S, Abbott GD, Wells JE, Mogridge N (2003) Fetal renal pelvic dilatation: poor predictor of familial vesico–ureteral reflux. Pediatr Nephrol 18:902–905

    Google Scholar 

  8. Nishisaki A (2003) Imaging studies after a first febrile urinary tract infection in young children (comment). N Engl J Med 348:1812

    Google Scholar 

  9. Dacher JN, Mandell J, Lebowitz RL (1992) Urinary tract infections in infants in spite of prenatal diagnosis of hydronephrosis. Pediatr Radiol 22:401–405

    Google Scholar 

  10. Dacher JN, Pfister C, Monroc M, Eurin D, Le Dosseur P (1996) Power Doppler sonographic pattern of acute pyelonephritis in children. Am J Roentgenol 166:1451–1455

    CAS  Google Scholar 

  11. Riccabona M, Fotter R (2004) Urinary tract infection in infants and children: an update with special regard to the changing role of reflux. Eur Radiol 14:L78–L88

    Google Scholar 

  12. Alon US, Ganapathy S (1999) Should renal ultrasonography be done routinely in children with urinary tract infection? Clin Pediatr 38:21–25

    Google Scholar 

  13. Morin D, Veyrac C, Kotzki PO et al. (1999) Comparison of ultrasound and DMSA scintigraphy changes in acute pyelonephritis. Pediatr Nephrol 13:219–222

    Google Scholar 

  14. Hitzel A, Liard A, Vera P, Manrique A, Menard JF, Dacher JN (2002) Color and power Doppler sonography versus DMSA scintigraphy in acute pyelonephritis and in prediction of renal scarring. J Nucl Med 43:27–32

    PubMed  Google Scholar 

  15. Dacher JN, Avni EF, François A et al. (1999) Renal sinus hyperechogenicity in acute pyelonephritis: description and pathological correlation. Pediatr Radiol 29:179–182

    Google Scholar 

  16. Dacher JN, Savoye-Collet C (2004) Urinary tract infection and functional bladder sphincter disorders in children. Eur Radiol 14:L101–L106

    Google Scholar 

  17. Paltiel HJ, Rupich RC, Kiruluta HG et al. (1992) Enhanced detection of vesico–ureteral reflux in infants and children with use of cyclic voiding cystourethrography. Radiology 184:753–755

    CAS  PubMed  Google Scholar 

  18. Franchi-Abella S, Waguet J, Aboun M, Sariego F, Pariente D (2000) Cyclic filling cystourethrography in the study of febrile urinary tract infection in children. J Radiol 81:1615–1618

    Google Scholar 

  19. Darge K (2002) Diagnosis of vesicoureteric reflux with ultrasonography. Pediatr Nephrol 17:52–60

    Article  PubMed  Google Scholar 

  20. Allen TD (1992) Commentary: voiding dysfunction and reflux. J Urol 148:1706–1707

    Google Scholar 

  21. Fotter R (2001) Functional disorders of the urinary tract. In: Fotter R (ed) Pediatric uroradiology. Springer, Berlin, Heidelberg, New York, pp 185–200

    Google Scholar 

  22. Badachi Y, Pietrera P, Liard A, Pfister C, Dacher JN (2002) Vesicoureteric reflux and dysfunctional voiding in children. J Radiol 83:1823–1827

    Google Scholar 

  23. Goldraich NP, Goldraich IH (1995) Update on DMSA renal scanning in children with urinary tract infection. Pediatr Nephrol 9:221–226

    Google Scholar 

  24. Piepsz A, Colarinha P, Gordon I et al. (2001) Paediatric Committee of the European Association of Nuclear Medicine. Guidelines for 99 mTc-DMSA scintigraphy in children. Eur J Nucl Med 28(3):37–41

    Google Scholar 

  25. Piepsz A, Blaufox MD, Gordon I et al. (1999) Consensus on renal cortical scintigraphy in children with urinary tract infection. Scientific Committee of Radionuclides in nephrourology. Semin Nucl Med 29:160–174

    CAS  PubMed  Google Scholar 

  26. Fleming JS, Cosgriff PS, Houston AS, Jarritt PH, Skrypniuk JV, Whalley DR (1998) UK audit of relative renal function measurement using DMSA scintigraphy. Nucl Med Commun 19:989–997

    Google Scholar 

  27. Majd M, Rushton HG (1992) Renal cortical scintigraphy in the diagnosis of acute pyelonephritis. Semin Nucl Med 22:98–111

    CAS  PubMed  Google Scholar 

  28. Patel K, Charron M, Hoberman A, Brown ML, Rogers KD (1993) Intra- and interobserver variability in interpretation of DMSA scans using a set of standardized criteria. Pediatr Radiol 23:506–509

    Google Scholar 

  29. Ditchfield MR, Grimwood K, Cook DJ et al. (2004) Persistent renal cortical scintigram defects in children 2 years after urinary tract infection. Pediatr Radiol 34:465–471

    Google Scholar 

  30. Hitzel A, Liard A, Dacher JN et al. (2004) Quantitative analysis of 99 m Tc-DMSA during acute pyelonephritis for prediction of long term renal scarring. J Nucl Med 45:285–289

    Google Scholar 

  31. Lonergan GJ, Pennington DJ, Morrison JC et al. (1998) Childhood pyelonephritis: comparison of gadolinium enhanced MR imaging and renal cortical scintigraphy for diagnosis. Radiology 207:377–384

    CAS  PubMed  Google Scholar 

  32. Naseer SR, Steinhardt GF (1997) New renal scars in children with urinary tract infections, vesico–ureteral reflux and voiding dysfunction: a prospective evaluation. J Urol 158:566–568

    Google Scholar 

  33. Pfister C, Dacher JN, Gaucher S, Liard-Zmuda A, Grise P, Mitrofanoff P (1999) The usefulness of minimal urodynamic evaluation and pelvic floor biofeedback in children with chronic voiding dysfunction. Br J Urol 84:1054–1057

    Google Scholar 

  34. Rohrschneider WK, Haufe S, Clorius JH, Tröger J (2003) MR to assess renal function in children. Eur Radiol 13:1033–1045

    Google Scholar 

  35. Wennerstrom M, Hansson S, Hedner T, Himmelmann A, Jodal U (2000) Ambulatory blood pressure 16–26 years after the first urinary tract infection. J Hypertens 18:485–491

    Google Scholar 

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Acknowledgements

The authors thank Richard Medeiros, Rouen University Hospital Medical Editor, for his advice in editing the manuscript.

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Correspondence to Jean-Nicolas Dacher.

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Dacher, JN., Hitzel, A., Avni, F.E. et al. Imaging strategies in pediatric urinary tract infection. Eur Radiol 15, 1283–1288 (2005). https://doi.org/10.1007/s00330-005-2702-4

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  • DOI: https://doi.org/10.1007/s00330-005-2702-4

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