Search Results (6)

Purpose: This study aims to evaluate the ability of radiomic features obtained from technetium-99m dimercaptosuccinic acid (Tc-99m DMSA) planar images to distinguish renal cortical uptake patterns among patients with chronic kidney disease (CKD). We also assessed the association between selected radiomic features and progressive renal function loss during follow-up. Methods: The study included a total of 185 patients: patients with Diabetes mellitus (DM) + hypertension (HTN) diagnosis (Group 1, n = 30), patients with HTN diagnosis alone (Group 2, n = 86), and patients with no history of DM or HTN who were followed for CKD (Group 3, n = 69). Intergroup comparisons were performed using the Kruskal–Wallis test with Bonferroni-corrected post hoc pairwise testing; the proportion of significantly different features was assessed using FDR correction. As a secondary exploratory analysis, the relationship between selected radiomic features and time to first observed ≥20% eGFR decline at follow-up was evaluated using univariate L2-penalised Cox proportional hazards regression with feature selection guided by the events-per-variable principle and model discrimination quantified using Harrell’s C-index. Results: Intensity Kurtosis values showed a statistically significant difference among the groups: −0.11 (−0.31 to 0.12) for Group 1, −0.24 (−0.41 to −0.04) for Group 2, and −0.33 (−0.45 to −0.16) for Group 3 (p = 0.001). Mean Intensity values were found to be 60.66 (31.01–89.39) in Group 1 and 90.46 (72.87–106.34) in Group 3 (p < 0.001). Age, gender, and baseline eGFR did not differ between groups. Radiomic analysis revealed significant intergroup differences predominantly in intensity- and texture-based features, while morphological features showed more limited differentiation. In the secondary exploratory longitudinal analysis, Centre of Mass Shift was the only morphological feature significantly associated with time to first observed ≥20% eGFR decline at follow-up (HR per SD: 0.74; 95% CI: 0.58–0.94; p = 0.015; C-index: 0.57). Conclusions: Radiomic features from Tc-99m DMSA planar images reveal quantitative differences between clinically defined CKD subgroups even when cortical uptake appears visually indistinguishable. The threshold-specific association of Centre of Mass Shift with subsequent eGFR decline, beyond baseline renal function, suggests that DMSA radiomics may provide exploratory prognostic information that warrants prospective validation. Full article

Background/Objectives: Renal scarring in children is linked to long-term complications, including hypertension and chronic kidney disease. Although dimercaptosuccinic acid (DMSA) scintigraphy is the reference standard, routine use is limited due to radiation exposure. This study evaluated whether multiparametric ultrasound combined with machine learning could predict DMSA-detected renal scarring in pediatric patients. Methods: In this retrospective study, 192 children undergoing renal ultrasound and DMSA scintigraphy were included. Renal morphometric and volumetric parameters, along with shear wave elastography, were analyzed. Supervised machine learning models were trained to predict renal scarring. A validated data augmentation framework addressed class imbalance and limited sample size. Model performance was assessed using standard classification metrics. Results: Kidney volume indexed to body surface area and the asymmetry index were strongly associated with renal scarring. Elastography alone had limited discriminatory power in conventional analyses but improved predictive performance when incorporated into machine learning models after data augmentation. Ensemble-based models achieved the highest accuracy and area under the receiver operating characteristic curve. Conclusions: Multiparametric ultrasound with machine learning shows potential as a noninvasive tool for predicting renal scarring in children. While not a replacement for DMSA scintigraphy, this approach may aid risk stratification and clinical decision-making, potentially reducing unnecessary radiation exposure. Full article

Background/Objectives: The Tc-99m dimercaptosuccinic acid (DMSA) renal scan clearly images the renal cortex, highlighting functional tissue areas and indicating regions of renal scarring, infection, malformations, or other types of renal damage. To enhance the management of paediatric cases involving renal malformations and to reduce the incidence of chronic and progressive kidney diseases in “future adults”, our study aims to identify and categorise various renal anomalies. Methods: This has been achieved by analysing the Tc-99m DMSA renal scans of a large cohort of 931 children diagnosed with different renal pathologies. After interpreting the scans, we categorised the renal malformations and cortical modifications into four groups: kidney number anomalies, positional anomalies, structural anomalies, and shape anomalies. Results: There has been a notable increase in the demand for renal scintigraphy in recent years, rising from 82 cases in 2019 to 183 cases in 2024. Structural anomalies were the most common type of malformations (73% from all patients), featuring a significant variety of cortical modifications. In total, 98 cases (93% from kidney number anomalies and 10.5% from all children) were diagnosed with renal agenesis. Additionally, 30 children (3.2% from all patients) had positional anomalies, primarily ectopic kidneys, and 54 patients (5.8% from all cases) had shape malformations, especially fused kidneys. Conclusions: Combining the Tc-99m DMSA renal scan with ultrasound provides a more reliable diagnosis of paediatric renal progressive diseases. A more accurate diagnosis allows for quicker treatment and prevention of potential complications, ultimately improving the quality of life and decreasing hospital costs of paediatric patients becoming adults. Full article

Vesicoureteral reflux (VUR) is defined as the urine backflow from the urinary bladder to the pyelo-caliceal system. In contrast, intrarenal reflux (IRR) is the backflow of urine from the renal calyces into the tubulointerstitial space. VURs, particularly those associated with IRR can result in reflux nephropathy when accompanied by urinary tract infection (UTI). The prevalence of IRR in patients with diagnosed VUR is 1–11% when using voiding cystourethrography (VCUG), while 11.9–61% when applying the contrast-enhanced voiding urosonography (ceVUS). The presence of IRR diagnosed by VCUG often correlates with parenchymal scars, when diagnosed by a 99mTc dimercaptosuccinic acid scan (DMSA scan), mostly in kidneys with high-grade VURs, and when diagnosed by ceVUS, it correlates with the wide spectrum of parenchymal changes on DMSA scan. The study performed by both ceVUS and DMSA scans showed IRRs associated with non-dilated VURs in 21% of all detected VURs. A significant difference regarding the existence of parenchymal damage was disclosed between the IRR-associated and IRR-non-associated VURs. A higher portion of parenchymal changes existed in the IRR-associated VURs, regardless of the VUR grade. That means that kidneys with IRR-associated VURs represent the high-risk group of VURs, which must be considered in the future classification of VURs. When using ceVUS, 62% of places where IRR was found were still unaffected by parenchymal changes. That was the basis for our recommendation of preventive use of long-term antibiotic prophylaxis until the IRR disappearance, regardless of the VUR grade. We propose a new classification of VURs using the ceVUS method, in which each VUR grade is subdivided based on the presence of an IRR. Full article

Background: Differentiating between febrile lower urinary tract infection (LUTI) and acute pyelonephritis (APN) is crucial for prompt clinical management. We investigated whether the high mobility group box-1 (HMGB1) could be a useful biomarker in differentiating between LUTI or APN. Methods: We enrolled seventy-four pediatric patients with suspected LUTI/APN, according to the positive or negative renal scintigraphy (DMSA) scan. If the first DMSA findings were abnormal, a second DMSA was performed after six months. Voiding cystourethrography ruled out vesicoureteral reflux (VUR). Results: Higher serum (s) HMGB1 levels characterized the APN group when compared to LUTI patients (13.3 (11.8–14.3) versus 5.9 (5.2–6.8) ng/mL, p: 0.02), whereas there were no differences according to urine (u) HMGB1 values. sHMGB1 correlated with C-reactive protein (CRP) levels (β = 0.47; p: 0.02). Receiver operating characteristic curves identified the best diagnostic profile for detecting APN. sHMGB1 area under the curve was different from CRP (p: 0.01) and white blood cells (p: 0.003). After multivariate analyses, VUR (HR:4.81) and sHMGB1 (HR 1.16; p: 0.006) were independently associated with the risk of renal scarring development. Conclusions: sHMGB1 could represent a marker to differentiate APN from LUTI. Measurement of sHMGB1 could select children for early intervention or long-term follow-up. Full article

^99mTc-dimercaptosuccinic acid (DMSA) scintigraphy is currently the method of choice for assessing renal scarring in children, but it is not established whether conducting the scan as a single photon emission tomography combined with low-dose CT (SPECT/ldCT) scan provides additional diagnostic benefits when compared to conventional planar scintigraphy. In the present study, we evaluated the interrater reliability of DMSA SPECT/ldCT vs. planar DMSA scintigraphy for diagnosing renal scarring. Methods: Two nuclear medicine physicians blinded to patient data retrospectively analysed all paediatric ^99mTc-DMSA scintigraphes that were conducted in our department for the assessment of post pyelonephritis renal scarring between 2011 and 2016. All scintigraphies included both a planar scan and SPECT/ldCT, and were performed on either a Phillips Precedence 16 slice CT or a Siemens Symbia 16 slice CT. The readers were blinded to each other’s readings and to patient data, and assessed all scans dichotomously for evidence of renal scarring. For each scan, the readers further noted if they were confident in their interpretation. Results: A total of 46 pairs of planar SPECT/ldCT DMSA scans were included. The readers were unconfident about their interpretation of 40% of the planar scans and 5% of the SPECT/ldCT scans. The interrater agreement rate was 72% for planar scans and 91% for SPECT/ldCT, and the corresponding Cohen’s kappa values were 0.38 and 0.79. Conclusion: DMSA SPECT/ldCT is associated with higher reader confidence and interrater reliability than conventional planar DMSA scintigraphy for the assessment of post pyelonephritis renal scarring in children. Full article