What is Dimercaptosuccinic acid (DMSA) cortical scintigraphy?

From the Guidelines

DMSA cortical scintigraphy is a specialized nuclear medicine imaging test used to evaluate kidney function and detect kidney damage or scarring, particularly valuable for identifying renal cortical scarring from conditions like pyelonephritis, assessing the relative function of each kidney, and evaluating kidney damage after urinary tract infections, especially in children, as supported by the most recent study from 2024 1.

Key Points About DMSA Cortical Scintigraphy

• The procedure involves injecting a small amount of a radioactive substance called technetium-99m DMSA (dimercaptosuccinic acid) into the bloodstream, which is then taken up by functioning kidney tissue.
• After the injection, a gamma camera captures images of the kidneys, showing how the radioactive material has been distributed throughout the kidney tissue.
• This test is sensitive (90%) and specific (95%) for detecting pyelonephritis, as noted in the 2024 study 1.
• The test results help physicians determine appropriate treatment plans for kidney conditions and monitor disease progression or recovery.

Clinical Applications

• Detecting renal cortical scarring: DMSA cortical scintigraphy is ideal for detecting focal renal parenchymal abnormalities and scars in the setting of acute or chronic pyelonephritis, as stated in the 2021 study 1.
• Assessing relative kidney function: The test can assess the relative function of each kidney, providing valuable information for clinical decision-making.
• Evaluating kidney damage after urinary tract infections: DMSA cortical scintigraphy is particularly useful in evaluating kidney damage after urinary tract infections, especially in children, as supported by the 2024 study 1.

Safety and Preparation

• The procedure is generally safe with minimal radiation exposure.
• Patients typically don't need special preparation beyond staying hydrated.
• The test takes about 2-4 hours to complete, as the radiotracer needs time to accumulate in the kidneys before imaging.

From the Research

Definition and Purpose of DMSA Cortical Scintigraphy

• Dimercaptosuccinic acid (DMSA) cortical scintigraphy is a medical imaging technique used to evaluate the renal cortex for signs of infection, scarring, or other damage 2, 3, 4, 5, 6.
• The technique involves injecting a small amount of technetium-99m labeled DMSA into the body, which then accumulates in the renal cortex and can be visualized using a gamma camera 2, 3, 4, 5, 6.

Clinical Applications of DMSA Cortical Scintigraphy

• DMSA cortical scintigraphy is commonly used to diagnose and evaluate acute pyelonephritis, a type of kidney infection that can cause scarring and permanent damage if left untreated 3, 4, 5, 6.
• The technique is also used to detect and monitor renal scarring, which can be a complication of recurrent urinary tract infections or other kidney diseases 2, 3, 5.
• DMSA cortical scintigraphy has been shown to be more sensitive than other imaging modalities, such as ultrasound and computed tomography, in detecting renal cortical defects and scarring 4, 5, 6.

Diagnostic Accuracy and Reliability

• Studies have demonstrated that DMSA cortical scintigraphy has high sensitivity and specificity for diagnosing acute pyelonephritis and detecting renal scarring 3, 4, 5, 6.
• The technique has been shown to be reliable in detecting renal cortical defects and scarring, even in patients with underlying kidney disease or other complicating factors 2, 3, 5.
• However, the diagnostic accuracy of DMSA cortical scintigraphy may be affected by factors such as the presence of vesicoureteral reflux or other underlying kidney diseases 3, 5, 6.