Meckel's diverticulum other imaging findings: Difference between revisions
No edit summary |
|||
Line 8: | Line 8: | ||
==Other Imaging Findings== | ==Other Imaging Findings== | ||
'''Technetium-99m pertechnetate radioisotope scanning''' | '''Technetium-99m pertechnetate radioisotope scanning''' | ||
* September 2014: Guidelines for the [[Nuclear medicine|Scintigraphy]] for Meckel’s diverticulum were laid down by: | * September 2014: Guidelines for the [[Nuclear medicine|Scintigraphy]] for Meckel’s diverticulum were laid down by:<ref name="pmid24948825">{{cite journal |vauthors=Spottswood SE, Pfluger T, Bartold SP, Brandon D, Burchell N, Delbeke D, Fink-Bennett DM, Hodges PK, Jolles PR, Lassmann M, Maurer AH, Seabold JE, Stabin MG, Treves ST, Vlajkovic M |title=SNMMI and EANM practice guideline for meckel diverticulum scintigraphy 2.0 |journal=J Nucl Med Technol |volume=42 |issue=3 |pages=163–9 |year=2014 |pmid=24948825 |doi=10.2967/jnmt.113.136242 |url=}}</ref> | ||
** Society of Nuclear Medicine and Molecular Imaging (SNMMI) | ** Society of Nuclear Medicine and Molecular Imaging (SNMMI) | ||
** European Association for Nuclear Medicine (EANM) | ** European Association for Nuclear Medicine (EANM) |
Revision as of 20:43, 28 December 2017
Meckel's diverticulum Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Meckel's diverticulum other imaging findings On the Web |
American Roentgen Ray Society Images of Meckel's diverticulum other imaging findings |
Risk calculators and risk factors for Meckel's diverticulum other imaging findings |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]
Overview
A technetium-99m (99mTc) pertechnetate scan is the investigation of choice for the diagnosis of Meckel's diverticulum. This scan detects gastric mucosa; since approximately 50% of symptomatic Meckel's diverticula have ectopic gastric (stomach) cells contained within them. A Meckel's diverticulum containing gastric mucosa manifests as a small rounded area of increased activity in the right lower quadrant, while normal activity simultaneously appears in the stomach.
Other Imaging Findings
Technetium-99m pertechnetate radioisotope scanning
- September 2014: Guidelines for the Scintigraphy for Meckel’s diverticulum were laid down by:[1]
- 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 cecum
- 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's diverticulum is required.
- A Meckel's diverticulum containing gastric mucosa manifests as a small rounded area of increased activity in the right lower quadrant.
- Normal activity simultaneously appears in the stomach.
- Technetium-99m pertechnetate scanning requires 30 images, taken at 1-minute intervals to demonstrate terminal ileum 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).
Angiography
- Angiography may assist in determining the location and severity of bleeding in case of a bleeding Meckel's diverticulum.
- In patients presenting with acute GI bleeding, superior mesenteric angiography is effective if blood loss exceeds 0.5 mL/min(brisk bleeding).
References
- ↑ Spottswood SE, Pfluger T, Bartold SP, Brandon D, Burchell N, Delbeke D, Fink-Bennett DM, Hodges PK, Jolles PR, Lassmann M, Maurer AH, Seabold JE, Stabin MG, Treves ST, Vlajkovic M (2014). "SNMMI and EANM practice guideline for meckel diverticulum scintigraphy 2.0". J Nucl Med Technol. 42 (3): 163–9. doi:10.2967/jnmt.113.136242. PMID 24948825.