Abstract

 

Objective: We aimed to assess the diagnostic performance of renal ultrasonography (USG) compared with technetium-99m dimercaptosuccinic acid renal cortical scintigraphy (DMSA scintigraphy) in detecting renal parenchymal damage in paediatric patients with vesicoureteral reflux (VUR) and/or recurrent urinary tract infection (rUTI).

Materials and Methods: We retrospectively analysed 181 paediatric patients who underwent both renal USG and DMSA scintigraphy. Kidneys coded as absent were excluded. Diagnostic accuracy indices (sensitivity, specificity, PPV, NPV, accuracy, and AUC with 95% confidence intervals) were calculated at kidney and patient levels. Logistic regression was performed to evaluate the impact of age, gender, and renal uptake.

Results: In comparison to DMSA scintigraphy as the reference standard, USG identified parenchymal damage with a sensitivity of 50.9% for the left kidney and 44.7% for the right kidney, while demonstrating exceptional specificity (>99%). At the patient level (n=162), USG achieved a sensitivity of 49.4%, specificity of 100%, accuracy of 76%, and AUC of 0.75. DMSA scintigraphy identified significantly more kidneys with parenchymal injury than USG in all age cohorts. Logistic regression further indicated that advancing age and diminished renal uptake on DMSA scintigraphy were independent predictors of parenchymal damage, while sex was not significant.

Conclusion: Ultrasonography demonstrated excellent specificity but limited sensitivity compared with DMSA scintigraphy. These findings indicate that USG alone is inadequate for the early detection of renal parenchymal damage in children with VUR and/or rUTI. DMSA scintigraphy remains essential in this high-risk population.

Keywords: Pyelonephritis, Tc-99m DMSA, urinary tract infections, ultrasonography, vesicoureteral reflux

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Copyright © 2026 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Tatoğlu MT, İbişoğlu E. Diagnostic accuracy of ultrasonography versus Tc-99m DMSA for detecting renal parenchymal damage in children with recurrent urinary fltract infections and vesicoureteral reflux: Patient-level and regression-based analyses. Turk J Pediatr Dis. 2026;Early View:1-6. https://doi.org/10.12956/TJPD.2026.1315