open access
Cortical scintigraphy in the evaluation of renal defects in children with vesico-ureteral reflux - optimization of the procedure and study interpretation
open access
Abstract
MATERIAL AND METHODS: The analysis is based on results of a planar kidney scintigraphy and of a tomographic (SPECT) procedure. The latter was performed in two variants: 1) in which slices were obtained with axis of reconstruction identical with longitudinal axis of the body (SPECT I) and 2) in which axes were fitted to the long axis of each kidney separately (SPECT II). The rating of the diagnosed pathology was made using two scales, according to Goldraich and Howard.
Evaluation of the images involved on the one hand, 150 individual kidneys and 75 patients on the other. The assessment was made by three independent observers, differing in experience in nuclear medicine and employed in three independent departments.
In the statistical analysis, as a measure of observer agreement, a proportion of agreeing readings (%) was accepted; in addition, the kappa index of agreement was calculated.
RESULTS: Better agreement among three observers was attained when planar images were read in contrast to SPECT (I and II) results.The reading of SPECT II images yielded a higher frequency of diagnosed pathology (scars) in kidneys and is characterized by better overall agreement in detection by individual observers than a similar evaluation of SPECT I images. The Goldraich scale secures better interobserver agreement of renal scar detection than is seen when the Howard scale was applied to acquire the rating.
CONCLUSIONS: The conclusion may be drawn that kidney scintigraphy is a method still burdened with a substantial subjectivism. Planar scintigraphy should be treated as a basic option for imaging post-inflammatory changes in kidneys.
Abstract
MATERIAL AND METHODS: The analysis is based on results of a planar kidney scintigraphy and of a tomographic (SPECT) procedure. The latter was performed in two variants: 1) in which slices were obtained with axis of reconstruction identical with longitudinal axis of the body (SPECT I) and 2) in which axes were fitted to the long axis of each kidney separately (SPECT II). The rating of the diagnosed pathology was made using two scales, according to Goldraich and Howard.
Evaluation of the images involved on the one hand, 150 individual kidneys and 75 patients on the other. The assessment was made by three independent observers, differing in experience in nuclear medicine and employed in three independent departments.
In the statistical analysis, as a measure of observer agreement, a proportion of agreeing readings (%) was accepted; in addition, the kappa index of agreement was calculated.
RESULTS: Better agreement among three observers was attained when planar images were read in contrast to SPECT (I and II) results.The reading of SPECT II images yielded a higher frequency of diagnosed pathology (scars) in kidneys and is characterized by better overall agreement in detection by individual observers than a similar evaluation of SPECT I images. The Goldraich scale secures better interobserver agreement of renal scar detection than is seen when the Howard scale was applied to acquire the rating.
CONCLUSIONS: The conclusion may be drawn that kidney scintigraphy is a method still burdened with a substantial subjectivism. Planar scintigraphy should be treated as a basic option for imaging post-inflammatory changes in kidneys.
Keywords
DMSA analogue; scintigraphy; kidney; renal scar; children; interobserver variability
Title
Cortical scintigraphy in the evaluation of renal defects in children with vesico-ureteral reflux - optimization of the procedure and study interpretation
Journal
Issue
Pages
157-164
Published online
2004-06-02
Page views
596
Article views/downloads
1438
Bibliographic record
Nucl. Med. Rev 2004;7(2):157-164.
Keywords
DMSA analogue
scintigraphy
kidney
renal scar
children
interobserver variability
Authors
Mariusz Gadzicki
Małgorzata Bińkiewicz
Ewa Młodkowska
Małgorzata Knapska
Magdalena Kowalewska-Pietrzak
Jacek Kuśmierek