European Journal of Biomedical and Pharmaceutical Sciences

ACCURACY OF ULTRASOUND DETECTION OF RENAL SCARRING AT QRH USING DMSA AS THE GOLD STANDARD

Salim M. Masadeh MD*, Mohammed H. Al Smadi MD, Ayat A al-Alwan MD, Firas H. Alsmadi MD, Mohammed Almulaifi MD, Awad M. Jarrar MD, Barak A. Alsubaie MD, Yahia A. Jaradat MD, Noor M. Masadeh MD and Wafa’ Shatnawi MD

ABSTRACT

Introduction: Renal ultrasound (US) and dimercaptosuccinic acid (DMSA) scintigraphy are key diagnostic tools for detecting renal scarring. While US is non-invasive, its sensitivity is limited, whereas DMSA, the gold standard, achieves sensitivity rates exceedin[g 90%. This study evaluates the accuracy of US compared to DMSA in pediatric patients to inform clinical decision-making and reduce unnecessary radiation exposure. Methods: This retrospective study included 346 pediatric patients who underwent both renal US and DMSA scintigraphy at Queen Rania Abdallah Hospital from November 2019 to October 2023. Patient demographics, imaging indications, and findings were analyzed. US performance was assessed against DMSA, focusing on sensitivity, positive predictive value (PPV), and diagnostic accuracy. Subgroup analyses were conducted based on age, gender, and clinical indication. Results: Ultrasound detected scarring in 162 of 393 affected renal units, compared to 346 identified by DMSA, yielding a sensitivity of 46.69% and a PPV of 100%. Sensitivity varied by subgroup: males (57.67%) outperformed females (36.96%), and infants (<2 years, 53.25%) outperformed preschool children (42.61%). Conditions like atrophied kidney and ureter stricture showed 100% sensitivity, while ectopic and polycystic kidneys showed none. Bilateral scarring was missed in 87% of cases by US. Conclusions: Ultrasound’s limited sensitivity and high false-negative rate underscore the necessity of DMSA for confirmatory diagnosis, particularly in high-risk cases. While US is valuable for initial screening, DMSA ensures accurate detection and optimal management of pediatric renal conditions. Future studies should refine imaging protocols and address dataset limitations to enhance diagnostic accuracy.

Keywords: Renal scarring, Renal ultrasound (US), dimercaptosuccinic acid (DMSA) scintigraphy.