This combination results in excellent lesion conspicuity. The rate of resolution of these defects is age dependent, clearing more slowly in infants and small children. DMSA and Glucoheptonate both produce diagnostic images, but unwanted collecting system activity presents more problems for Glucoheptonate. Furosemide, hydration, and delayed imaging may overcome this problem in patients with hydronephrosis. DMSA is also clearly superior to other agents such as gallium and In-111 WBC's for the evaluation of pyelonephritis in children.
Gallium results in an inordinate delay to diagnosis and a larger radiation exposure.
High splenic exposure and large blood volumes for labeling limit the use of radiolabeled WBC's in the pediatric population. When there is a significant depth discrepancy between the two kidneys, anterior and posterior images should be acquired and a geometric mean determined.