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

Technetium-99m pertechnetate radioisotope scanning

• September 2014: Guidelines for the Scintigraphy for Meckel’s diverticulum were laid down by:
  • Society of Nuclear Medicine and Molecular Imaging (SNMMI)
  • European Association for Nuclear Medicine (EANM)
• Technetium-99m pertechnetate scanning helps in the detection of a symptomatic bleeding Meckel’s diverticulum.
• It is preferred as the investigation of choice for the diagnosis of Meckel's diverticula in children due to the following features:
  • High accuracy
  • Noninvasive nature
  • 95% specificity
  • 85% sensitivity
  • Approximately 50% of symptomatic Meckel's diverticula have ectopic gastric or pancreatic cells contained within them
• Technetium-99m pertechnetate scanning is not preferred in adults as false negative rates are high with specificity of 9% and sensitivity of 62%.
• False-positives are seen in the following conditions:
  • Intussusception
  • Volvulus
  • Obstruction of the small intestine
  • Acute appendicitis
  • Carcinoid of the appendix
  • Carcinoma of the caecum
• On intravenous administration, the Technetium-99m pertechnate radioisotope is taken up by the gastric mucosa.
• In order to obtain a positive result, atleast 1.8 cm2 of ectopic gastric mucosa in Meckel diverticulum is required.
• Technetium-99m pertechnetate scanning requires 30 images, taken at 1-minute intervals to demonstrate terminal ileal activity.
• The use of Pentagastrin in Technetium-99m pertechnetate scanning has a synergistic effect:
• Role of Pentagastrin:
  • Histamine-2 (H2) receptor blocker
  • Enhances radioisotope uptake by the cells:
    • Promotes isotope retention
    • Blocks intraluminal release of isotope
    • Minimizes false negative results
• 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.

Angiography angiography may assist in determining the location and severity of bleeding In patients presenting with acute GI bleeding, superior mesenteric angiography is effective if blood loss exceeds 0.5 mL/min(brisk bleeding)