Meckel's diverticulum other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A technetium-99m (99mTc) pertechnetate scan is the investigation of choice to diagnose Meckel's diverticula. This scan detects gastric mucosa; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric (stomach) cells contained within them, this is displayed as a spot on the scan distant from the stomach itself.

Other Imaging Findings

• Meckel's diverticulum is identified as a saccular, blind-ending structure located on the antimesenteric border of the ileum.
• Meckel's diverticulum is usually found in the right lower quadrant and pelvic region.
• The junction of the diverticulum with the ileum may show a mucosal triangular plateau or triradiate fold pattern (represents the site of omphalomesenteric duct attachment to the ileum).
• Filling defects within the diverticulum may represent enteroliths, fecoliths, or foreign bodies.

• Pertechnetate scan: A technetium-99m (99mTc) pertechnetate scan is the investigation of choice to diagnose Meckel's diverticula. This scan detects gastric mucosa; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric (stomach) cells contained within them, this is displayed as a spot on the scan distant from the stomach itself. Patients with these misplaced gastric cells may experience peptic ulcers as a consequence.
  • Technetium-99m pertechnetate scintigraphy is the modality of choice for evaluating pediatric patients with gastrointestinal hemorrhage and a suspected Meckel diverticulum.
  • A Meckel diverticulum containing gastric mucosa will manifest as a small rounded area of increased activity in the right lower quadrant.
  • Normal activity will simultaneously appear in the stomach.

Positive Technetium-99m pertechnetate scan

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Technetium-99m pertechnate radioisotope scanning:

Helps in the detection of a symptomatic bleeding Meckel’s diverticulum investigation of choice to diagnose Meckel's diverticula in children: highly accurate and noninvasive, with 95% specificity and 85% sensitivity False negative rates high in adults: only 9% specific and 62% sensitive The Technetium-99m pertechnate radioisotope is taken up by the gastric mucosa on intravenous administration In order to obtain a positive result, atleast 1.8 cm2 of ectopic gastric mucosa in Meckel diverticulum is required approximately 50% of symptomatic Meckel's diverticula have ectopic gastric or pancreatic cells contained within them, this is displayed as a spot on the scan distant from the stomach itself.

Requires 30 images, taken at 1-minute intervals to demonstrate terminal ileal activity

Pentagastrin: Histamine-2 (H2) receptor blocker Enhances radioisotope uptake by the cells: Promotes isotope retention Blocks intraluminal release of isotope Minimizes false negative results

False-positives seen in: Intussusception Volvulus obstruction of the small intestine acute appendicitis carcinoid of the appendix carcinoma of the caecum.

September 2014: Guidelines for the Scintigraphy for Meckel’s diverticulum: Society of Nuclear Medicine and Molecular Imaging (SNMMI) European Association for Nuclear Medicine (EANM)