Bin Ji

Qian Xie

Qiang Wen

Qingjie Ma

Shi Gao

SpringerPlus

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Xie et al. SpringerPlus  (2016) 5:1270 
DOI 10.1186/s40064-016-2928-4
CASE STUDY
Incremental value of SPECT/CT 
in detection of Meckel’s diverticulum in a 
10-year-old child
Qian Xie, Qingjie Ma, Bin Ji, Shi Gao and Qiang Wen*
Abstract 
Introduction: Meckel’s diverticulum is a common congenital abnormality of gastrointestinal tract in children. Planar 
scintigraphy using Technetium-99m pertechnetate is widely used in the diagnosis of Meckel’s diverticulum. Single 
photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging may help to locate the 
Meckel’s diverticulum lesion. We now present a Meckel’s diverticulum case which tends to be missed.
Case description: The patient was diagnosed with Mecke’s diverticulum by planar scintigraphy in 2007. After seven 
years, a recurrence of hematochezia made the patient undergo planar scintigraphy again. However, the concentration 
on planar image was located at the right kidney level, we could not determine whether it was caused by physiologi-
cal uptake of the right kidney or by an ectopic gastric mucosa. Using SPECT/CT technique, we confirmed that the 
lower part of the concentration was from a Meckel’s diverticulum from the small intestine based on the functional 
and anatomical information together.
Discussion and Evaluation: For concentrations about the kidney level, planar scintigraphy is not enough to be diag-
nostic of Meckel’s diverticulum. SPECT/CT imaging may be beneficial for a definitive diagnosis. Also, fusion images 
may provide precise localization of the lesion. To make sure that patients obtain optimal benefit from a SPECT/CT 
examination, we have to balance the priority between information of anatomic location and avoiding redundant 
radiation to the patients.
Conclusions: Our case study suggest that for cases with ambiguous planar scintigraphy images, SPECT/CT imaging 
should be performed to obtain a definitive diagnosis.
Keywords: Meckel’s diverticulum, Planar scintigraphy, SPECT/CT
© 2016 The Author(s). This article is distributed under the terms of the Creative Commons Attribution 4.0 International License 
(http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, 
provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, 
and indicate if changes were made.
Background
Meckel’s diverticulum is a common congenital abnormal-
ity of gastrointestinal tract. The incidence is about 2–3 % 
worldwide (Levy and Hobbs 2004). Although bleeding, 
bowel obstruction, vomiting and nausea are commonly 
seen (Menezes et  al. 2008; Ruscher et  al. 2011; Cobellis 
et al. 2007; Mukai et al. 2002; Prasad et al. 2006; Rashid 
et al. 2012; Rho et al. 2013), typical symptoms and specific 
signs are difficult to identify. Multiple techniques have 
been used to detect Meckel’s diverticulum. However, the 
value of X-ray barium meal radiography and video image 
endoscope in detecting Meckel’s diverticulum is limited, 
because some patients cannot tolerate discomfort or pain 
during these examination processes. More than 90 % of 
Meckel’s diverticulum with gastrointestinal bleeding 
is with heterotypic gastric mucosa. As ectopic gastric 
mucosa could take in and concentrate Technetium-99 m 
pertechnetate promptly, planar scintigraphy has been 
widely used in the detection of Meckel’s diverticulum. 
Hybrid single photon emission computed tomography/
computed tomography (SPECT/CT) enables a direct cor-
relation of anatomical information and functional infor-
mation, resulting in better localization and definition of 
scintigraphic findings (Even-Sapir et  al. 2009). It is now 
Open Access
*Correspondence:  yutaixq@126.com 
Department of Nuclear Medicine, China-Japan Union Hospital, Jilin 
University, 126 Xiantai Avenue, Changchun 130033, China
Page 2 of 4Xie et al. SpringerPlus  (2016) 5:1270 
more and more frequently used in the diagnosis of Meck-
el’s diverticulum.
Case report
A 3-year-old female patient was admitted in our institu-
tion due to 3  days of maroon stools in 2007. No active 
bleeding was found by gastroscopy, colonoscopy or 
abdominal/pelvic CT. Planar scintigraphy showed a focal 
concentration at the small intestine region of the lower 
abdomen (Fig.  1). She was diagnosed as Meckel’s diver-
ticulum. Because this patient has a history of congenital 
heart disease, she did not have a surgery with this lesion. 
She stopped having maroon stools the following day and 
left the hospital.
The patient was again admitted in our hospital due to 
massive hematochezia in 2013. Physical examination 
was normal except for an abdominal tenderness. Serum 
hemoglobin concentration was 76  g/L. Esophagogas-
troscopy (EGD), colonoscopy and abdominal/pelvic CT 
were done and no active bleeding site was found. To 
look for the source of bleeding, we performed a planar 
scintigraphy again. We found two focal concentrations 
under the liver at the right lower quadrant of abdomen 
region. We could not determine whether it was caused by 
physiological uptake of the right kidney or by an ectopic 
gastric mucosa (Fig. 2). Delayed imaging was performed 
after 20 and 60  min, respectively. At the delayed phase, 
the degree of the uptake in the lower part of this concen-
tration changes simultaneously with that of the stomach.
Considering that the patient had been diagnosed 
with Meckel’s diverticulum 7 years ago, we performed a 
SPECT/CT fusion imaging to the patient (Fig. 3). Based 
on the fused image, we found that the focal concentra-
tion was not from the right kidney. Therefore, a diagno-
sis of Meckel’s diverticulum was confirmed. The patient 
underwent surgical diverticulectomy the following day. 
The surgeon found a 3 cm Meckel’s diverticulum which 
located in the ileum within 15 cm of the ileocecal valve. 
Histological examination of the lesion revealed an 
ectopic gastric mucosa. The patient remains asympto-
matic without any gastrointestinal bleeding or maroon 
stools 14 months after the surgery.
Fig. 1 5 min (a), 20 min (b) and 60 min (c) after administering 1 mCi of Technetium-99 m pertechnetate intravenously, planar scintigraphy was 
performed respectively. Images showed a focal concentration at the small intestine region of the lower abdomen
Fig. 2 5 min (a), 20 min (b) and 60 min (c) after administering 1.5 mCi of Technetium-99 m pertechnetate intravenously, planar scintigraphy was 
performed respectively. Images showed two focal concentrations under the liver at the right lower quadrant of abdomen region
Page 3 of 4Xie et al. SpringerPlus  (2016) 5:1270 
Discussion
Technetium-99  m pertechnetate planar scintigra-
phy is widely used in the diagnosis of Meckel’s diver-
ticulum (Sfakianakis and Conway 1981). Because 
Technetium-99  m pertechnetate is excreted by the uri-
nary system, kidney and urinary tract are normally with 
concentrations, which may overlap with that in Meck-
el’s diverticulum on the planar image and lead to false 
result. In our case, a diagnosis of Meckel’s diverticulum 
has been made by a former planar scintigraphy. How-
ever, when the patient underwent planar scintigraphy 
7  years later, we were unable to determine whether the 
focal concentration was caused by physiological uptake 
of the right kidney or by ectopic gastric mucosa. To look 
for the exact anatomic site of the focal concentration, we 
performed a SPECT/CT scan to the patient. The educa-
tional significance of our report was that, for the Meckel’s 
diverticulum of the kidney level, SPECT/CT should be 
always performed to avoid false result due to physiologi-
cal uptake of the kidney. Due to the puberty age of the 
patient, the relative position of Meckel’s diverticulum 
may have been changed compared to the lesion identified 
7 years ago.
The use of SPECT/CT fusion imaging provided valu-
able diagnostic information and avoided false nega-
tive study (Swaniker et  al. 1999; Jonathan 2009). Once 
a Meckel’s diverticulum was missed, the patient would 
not receive effective treatment and suffer serious further 
complications. Furthermore, SPECT/CT fusion imag-
ing may provide functional and anatomical information 
together to help surgeons to plan the surgery.
Compared with planar scintigraphy, SPECT/CT is with 
relatively high cost and increased radiation from the CT 
portion. Also, Meckel’s diverticulum patients are usually 
children under 10 years old. Therefore, SPECT/CT fusion 
imaging still has not been routinely used in diagnosis of 
Meckel’s diverticulum. In our case, to minimize radiation 
exposure to the patient, we set the scanning range from 
2  cm below the xiphoid to inferior pole of kidneys to 
locate the lesion. The tube voltage was set at 100 kV and 
the tube current was set at 20 mA (Gelfand and Lemen 
2007; Lee et al. 2015; Goo 2012). Through these methods, 
the radiation dose of the CT portion can be reduced by 
more than 60 %.
For concentrations about the kidney level, planar scin-
tigraphy is not enough to be diagnostic of Meckel’s diver-
ticulum. SPECT/CT imaging may be beneficial for a 
definitive diagnosis. Also, fusion images may provide pre-
cise localization of the lesion. To make sure that patients 
obtain optimal benefit from a SPECT/CT examination, 
we have to balance the priority between information of 
anatomic location and avoiding redundant radiation to 
the patients.
Conclusion
For cases with ambiguous planar scintigraphy images, 
SPECT/CT imaging should be performed to obtain a 
definitive diagnosis.
Authors’ contributions
 QX, QM and SG designed the report; QM and QW performed the examina-
tion; QX and BJ collected the patient’s clinical data; QX, SG and BJ analyzed the 
data and wrote the paper. All authors read and approved the final manuscript.
Acknowledgements
The authors wish to acknowledge Professor Liulin. Department of Radiological 
China-Japan Union Hospital, Jilin University, Changchun 130033, China.
Competing interests
The authors declare that they have no competing interests.
Additional file
Additional file 1. Information about the patient.
Fig. 3 Axial SPECT/CT image of the Meckel’s diverticulum. a Axial image SPECT shows one focal concentration in the right abdomen (arrow). b CT 
demonstrated a blind-ending tubular structure in the right abdomen (arrow). Anatomical relationship between the focal concentration and right 
kidney cannot be identified. c Axial SPECT/CT fusion image showed that it was in front of the kidney that the focal concentration lays (arrows)
Page 4 of 4Xie et al. SpringerPlus  (2016) 5:1270 
Informed consent
 Written informed consent was obtained from the patient’s parents, they gave 
their consent for the use of the patient’s medical and personal information for 
the publication of this case report and any accompanying images. A copy of 
signed form of the consent form is available for review by the Editor-in Chief 
of this journal (See Additional file 1).
Received: 9 December 2015   Accepted: 27 July 2016
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Incremental value of SPECT/CT in detection of Meckel’s diverticulum in a 10-year-old child

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Incremental value of SPECT/CT in detection of Meckel’s diverticulum in a 10-year-old child

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