Wu Ha, Zhao Xiaofei, Li Yiwei, Zhao Ruifang
Department of Nuclear Medicine, Children's Hospital of Fudan University, No. 399 Wanyuan Road, Minhang District, Shanghai 201102, China.
Hell J Nucl Med. 2017 Jan-Apr;20(1):11-16. doi: 10.1967/s002449910501. Epub 2017 Mar 20.
Meckel's diverticulum scintigraphy (MDS) is a common method for diagnosing ectopic gastric mucosa (EGM), but atypical images are difficult to diagnose. This study aimed to improve the understanding of the existing diagnostic criteria through a review of confirmed cases.
A total of 352 patients underwent MDS. Among 120 patients with a positive diagnosis, 106 underwent surgery. This study analyzed the imaging presentation, surgical records, and pathological results. The existing diagnostic criteria included the location, shape, and radioactive appearance of the lesions. Data from surgical records with typical or atypical images were compared.
One hundred cases (100/106) were surgically confirmed to be Meckel's diverticulum (MD). The remaining 6 were intestinal polyps, intestinal duplication, duodenal ulcer, non-Hodgkin's lymphoma (NHL) and hiatal hernia. Out of the 100 MD cases, 93 had complete operation records and 59/93 of the MDS 63.4% MD were located in the right lower quadrant, and 81.7% had a round shape in the scintiscan. The onset of the lesions activity in 96.8% (90/93) of the cases corresponded with the onset of the gastric activity. The radioactivity of 97.8% (91/93) of the lesions gradually increased during the examination. There were no significant differences between the typical and atypical scintiscan images: in the distance of MD from the ileocecal valve, in the MD length, and the basal diameter of MD for lesions at different scintiscans (P>0.05), or of different shapes (P>0.05).
Location in the right lower quadrant and round shape of the lesions are not the primary diagnostic factors for Meckel's diverticulum. The establishment of the diagnosis of MD requires careful consideration of other imaging characteristics such as: a) The onset of lesions' radioactivity to correspond with the onset of the gastric activity and b) The lesions' radioactivity to gradually increase during the scan procedure.
梅克尔憩室闪烁扫描（MDS）是诊断异位胃黏膜（EGM）的常用方法，但非典型图像难以诊断。本研究旨在通过回顾确诊病例来加深对现有诊断标准的理解。
共有352例患者接受了MDS检查。在120例诊断阳性的患者中，106例接受了手术。本研究分析了影像表现、手术记录和病理结果。现有的诊断标准包括病变的位置、形态和放射性表现。比较了具有典型或非典型图像的手术记录数据。
106例患者中有100例经手术确诊为梅克尔憩室（MD）。其余6例为肠息肉、肠重复畸形、十二指肠溃疡、非霍奇金淋巴瘤（NHL）和食管裂孔疝。在100例MD病例中，93例有完整的手术记录，MDS诊断为MD的病例中，59/93（63.4%）位于右下腹，81.7%在闪烁扫描中呈圆形。96.8%（90/93）的病例病变活动起始与胃活动起始一致。97.8%（91/93）的病变在检查过程中放射性逐渐增加。典型和非典型闪烁扫描图像在MD距回盲瓣的距离、MD长度以及不同闪烁扫描病变的MD基底直径方面无显著差异（P>0.05），不同形态的病变也无显著差异（P>0.05）。
病变位于右下腹和圆形并非梅克尔憩室的主要诊断因素。MD的诊断确立需要仔细考虑其他影像特征，如：a）病变放射性起始与胃活动起始一致；b）扫描过程中病变放射性逐渐增加。
