대한핵의학회지 (The Korean Journal of Nuclear Medicine)

대한핵의학회 (The Korean Society of Nuclear Medicine)
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성인 요로 감염 환자에서 $^{99m}Tc-DMSA$ 삼중검출기 SPECT 영상의 유용성

Triple Detector SPECT Imaging with $^{99m}Tc-DMSA$ in Adult Patients with Urinary Tract Infection

  • 류진숙 (울산대학교 의과대학 서울중앙병원 핵의학과) ;
  • 배원규 (울산대학교 의과대학 서울중앙병원 핵의학과) ;
  • 문대혁 (울산대학교 의과대학 서울중앙병원 핵의학과) ;
  • 이명혜 (울산대학교 의과대학 서울중앙병원 핵의학과) ;
  • 김순배 (울산대학교 의과대학 서울중앙병원 내과) ;
  • 박수길 (울산대학교 의과대학 서울중앙병원 내과) ;
  • 박정식 (울산대학교 의과대학 서울중앙병원 내과) ;
  • 홍창기 (울산대학교 의과대학 서울중앙병원 내과) ;
  • 조경식 (울산대학교 의과대학 서울중앙병원 진단방사선과)
  • Ryu Jin-Sook (Department of Nuclear Medicine, Asan Medical Center College of Medicine, University of Ulsan) ;
  • Bae, Won-Gyu (Department of Nuclear Medicine, Asan Medical Center College of Medicine, University of Ulsan) ;
  • Moon Dae-Hyuk (Department of Nuclear Medicine, Asan Medical Center College of Medicine, University of Ulsan) ;
  • Lee, Myung-Hae (Department of Nuclear Medicine, Asan Medical Center College of Medicine, University of Ulsan) ;
  • Kim, Soon-Bae, (Department of Internal Medicine, Asan Medical Center College of Medicine, University of Ulsan) ;
  • Park, Su-Kil (Department of Internal Medicine, Asan Medical Center College of Medicine, University of Ulsan) ;
  • Park, Jung-Sik (Department of Internal Medicine, Asan Medical Center College of Medicine, University of Ulsan) ;
  • Hong, Chang-Gi D. (Department of Internal Medicine, Asan Medical Center College of Medicine, University of Ulsan) ;
  • Cho, Kyung-Sik (Department of Radiology, Asan Medical Center College of Medicine, University of Ulsan)
  • 발행 : 1992.12.31
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초록

Although early diagnosis of urinary tract infection is important, the radiologic evaluation is still controversial because of the low sensitivity and the lack of cost-effectiveness. This study was carried out to evaluate the clinical utility of high resolution triple head $^{99m}Tc-DMSA$ SPECT imaging in urinary tract infection. We prospectively performed $^{99m}Tc-DMSA$ planar and SPECT imaging, ultrasound of kidney (US), intravenous pyelography (IVP) and voiding cystourethrography (VCU) in all 60 adult patients with UTI [26 with first episode of acute pyelonephritis (APN), 22 with recurrent APN, and 12 persistent asymptomatic pyuria] and 25 normal persons. To assess reversibility of the renal cortical defect (RCD), $^{99m}Tc-DMSA$ SPECT was repeated 1 to 8 months later in those patients with abnormal initial findings. Overall detection rate of $^{99m}Tc-DMSA$ SPECT imaging was 83% (50/60), but planar, US, IVP and VCU showed abnormal findings in 68%, 28%, 32% and 13%, respectively. 25 out of 27 patients with normal or single RCD were all normal in other radioligic studies. Only two patients showed vesicoureteral reflux (VUR) on VCU (grade I) and mild hydronephrosis on IVP. But, high proportion of those with multiple RCD showed abnormal findings on US (17/33), IVP (18/33), and VCU (7/33): 67% in any of these 3 studies. Especially, 3 out 7 patients with VUR showed multiple RCD on $^{99m}Tc-DMSA$ SPECT without any abnormality on IVP or US. 25 normal persons showed normal findings in all studies except one false positive finding on $^{99m}Tc-DMSA$ SPECT imaging. Follow-up $^{99m}Tc-DMSA$ SPECT was done in 28 patients (13 with single RCD, 15 with multiple RCD). All 13 patients with single RCD showed improvement. Those with multiple RCD presented improvement in 4, no change in 10, and aggravation in 1 on follow-up studies. With these results, we conclude: 1) $^{99m}Tc-DMSA$ SPECT imaging is superior to planar imaging, US, IVP or VCU in detection of renal lesion in urinary tract infection. $^{99m}Tc-DMSA$ SPECT is useful as a initial diagnostic tool in adult patients with urinary tract infection. 2) The multiple RCD on $^{99m}Tc-DMSA$ SPECT represent the high probability of irreversible tissue change and need of extensive urological work-up.

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