Meckel’s scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years

Sinha, Chandni; Pallewatte, Aruna; Easty, Marina; Coppi, Paolo De; Pierro, Agostino; Misra, Devesh; Biassoni, Lorenzo

doi:10.1007/s00383-013-3270-3

Cited by 56 publications

(42 citation statements)

References 15 publications

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“…Although they reported a negative predictive value for the Tc-99m-pertechnetate scan of only 22% (well below what is reported in the recent literature [2][3][4]), the positive predictive value was reported to be 64%.The results of the Tc-99m-pertechnetate study in this paper are significantly different from those of our recently published series of over 180 cases [2]. This raises several questions.…”

contrasting

confidence: 82%

“…The results of the Tc-99m-pertechnetate study in this paper are significantly different from those of our recently published series of over 180 cases [2]. This raises several questions.…”

contrasting

confidence: 74%

contrasting

confidence: 56%

See 2 more Smart Citations

Technetium-99m-pertechnetate scintigraphy in children with symptomatic Meckel’s diverticulum

Biassoni

Easty²,

Sinha³

2015

Nuclear Medicine Communications

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We read with interest the article published in a recent issue of Nuclear Medicine Communications by Al-Janabi et al.[1] on their experience with technetium (Tc)-99m-pertechnetate scintigraphy in children with symptomatic Meckel's diverticulum.The authors studied 73 children with symptomatic Meckel's diverticulum, with a high prevalence of ectopic gastric mucosa (84%). Although they reported a negative predictive value for the Tc-99m-pertechnetate scan of only 22% (well below what is reported in the recent literature [2][3][4]), the positive predictive value was reported to be 64%.The results of the Tc-99m-pertechnetate study in this paper are significantly different from those of our recently published series of over 180 cases [2]. This raises several questions.First, we are puzzled by the study population. The authors state that the study was prospective in nature, but they do not mention the inclusion and exclusion criteria at entry -that is, before the Tc-99m-pertechnetate scan was performed [1]. Their patients were those with a final definitive or suspected diagnosis of Meckel's diverticulum; however, they do not say on what basis this diagnosis was made (whether on pathology after surgery or on other criteria). They also excluded 27 children with intestinal duplication and incidental Meckel's diverticulectomy (n = 11), but do not give reasons for this. The patients appear to have been selected after the Tc-99m-pertechnetate scintigraphy was performed and the diagnosis made (cf. first two lines of page 1163), which would skew the study findings. Therefore, it remains unclear from their description whether this was a truly prospective study or was in fact a retrospective review following surgical confirmation. Their study population includes a significant proportion of acute cases [32/73 (44%) patients presented with complications]: this is not the typical patient population referred for a Tc-99m-pertechnetate scan.Second, we find the details of the Tc-99m-pertechnetate scan acquisition concerning. The authors have injected an isotope activity ranging between 0.5 and 1.0 MBq/kg body weight of Tc-99m-pertechnetate: this is 2-3 times lower than the activity recommended in the EANM SNMMI guidelines (1.85 MBq/kg) [3]. The guidelines recommend a minimum injected activity of 9.25 MBq. If the EANM paediatric dosage card (http://www.eanm.org/ publications/dosage_calculator) had been used, the minimum injected activity would have been 20 MBq. With the activity injected in this study the count rate is significantly lower and the ability to detect small focal areas is reduced.With regard to the use of premedication with either proton pump inhibitors, histamine H 2 -blockers, or glucagon (to limit gastric secretions thus improving image quality), we are well aware that this is still controversial; however, the guidelines do recommend it [3]. Premedication was not used in this study.The guidelines recommend obtaining static and postvoid images at the end of the dynamic acquisition to help in differentiating between urinary...

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contrasting

confidence: 82%

“…The results of the Tc-99m-pertechnetate study in this paper are significantly different from those of our recently published series of over 180 cases [2]. This raises several questions.…”

contrasting

confidence: 74%

See 1 more Smart Citation

Technetium-99m-pertechnetate scintigraphy in children with symptomatic Meckel’s diverticulum

Biassoni

Easty²,

Sinha³

2015

Nuclear Medicine Communications

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“…CE was able to depict small bowel ulcers, villous denudation, and proximal disease that usually are undetectable by MR, while MR demonstrates extraintestinal disease and excludes patients with strictures [26]. Furthermore, it equally important to exclude a Meckel's diverticulum at the beginning of the diagnostic work-up (when suggestive symptoms are present) in order to minimize the time to diagnosis and optimize resources, offering the best and the fastest therapy for these patients and preventing complications [27].…”

Section: Discussionmentioning

confidence: 98%

Capsule endoscopy followed by single balloon enteroscopy in children with obscure gastrointestinal bleeding: A combined approach

Oliva

Pennazio²,

Cohen

et al. 2015

Digestive and Liver Disease

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“…The sensitivity of 99m Tc-Na-pertechnetate scintigraphy in adults is approximately 60% in adults and 60% to 94% in children. [37][38][39] Pretreatment with pentagastrin, histamine H2 blockers, and/or glucagon can increase sensitivity of 99m Tc-Na-pertechnetate scintigraphy. 40 A normal Meckel diverticulum is difficult to differentiate from normal small bowel, although in some cases a blind-ending structure in continuity with the ileum may be identified (Fig.…”

Section: Meckel Diverticulummentioning

confidence: 97%

Evaluating the Patient with Right Lower Quadrant Pain

Patel

Wenzke

2015

Radiologic Clinics of North America

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Meckel’s scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years

Cited by 56 publications

References 15 publications

Technetium-99m-pertechnetate scintigraphy in children with symptomatic Meckel’s diverticulum

Technetium-99m-pertechnetate scintigraphy in children with symptomatic Meckel’s diverticulum

Capsule endoscopy followed by single balloon enteroscopy in children with obscure gastrointestinal bleeding: A combined approach

Evaluating the Patient with Right Lower Quadrant Pain

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