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False positive in the detection of ectopic gastric mucosa in 99mTc-pertechnetate abdominal scintigraphy
Rev Esp Med Nucl. 2010;29(6):310-311
Image of interest
False positive in the detection of ectopic gastric mucosa in 99mTc-pertechnetate abdominal scintigraphy Falso positivo en la detección de mucosa gástrica ectópica en la gammagrafía abdominal con Tc99m-pertecnetato A. Santiago Chinchilla *, C. Ramos-Font, H. Palacios Gerona, M. Moreno Caballero, A.C. Rebollo Aguirre and J.M. Llamas Elvira Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain
information on the article
History of the article: Received: May 18, 2010 Accepted: June 9, 2010
A 12-year-old male was admitted for rectorrhagias. Abdominal scintigraphy with 99mTc-pertechnetate was requested for clinical suspicion of Meckel diverticulum (MD). Early phases of the study showed supravesical foci simultaneous to gastric activity which persisted in late images but of lesser uptake intensity than that of the stomach (fig. 1). Given the slight intensity, images were obtained in posterior projection although MD is usually visualized in anterior projection in the inferior hemiabdomen.1,2 The study showed the
same foci but with a similar intensity of gastric mucosa (fig. 2) being interpreted as positive for MD. The patient underwent surgery with complete resection of the diverticulum. The result was complicated MD with diverticulitis without ectopic gastric mucosa. False positive cases have been reported in the detection of ectopic gastric mucosa with abdominal scintigraphy with 99mTcpertechnetate due to inflammatory processes such as diverticulitis.3
Figure 1. Abdominal scintigraphy with an intravenous bolus of 99mTc-pertechnetate (185 mBq [5 mCi]). A) Early anterior projection (25 min). B) Late anterior projections (45 and 60 min.). The sequential images obtained during the first 25 minutes of examination show the appearance of foci simultaneous to gastric mucosa activity but of lesser intensity situated in the medial line above the urinary bladder which displaced toward the right iliac fossa on urination and persisted in the late images. The slight intensity of the foci did not allow the study to be considered completely positive leading to the performance of posterior projections for better visualization.
* Corresponding author. E-mail address: [email protected], [email protected] (A. Santiago Chinchilla). 0212-6982/$ - see front matter © 2010 Elsevier España, S.L. and SEMNIM. All rights reserved.
A. Santiago Chinchilla et al / Rev Esp Med Nucl. 2010;29(6):310-311
311
Figure 2. Abdominal scintigraphy with an intravenous bolus of 99mTc-pertechnetate (185 mBq [5 mCi]). A,B) Late posterior projections (45 and 60 min.). The posterior projections demonstrated the foci with greater clarity and with an intensity similar to that of the gastric mucosa at a right posterior supravesical level showing positivity for MD and leading to surgery with complete resection of the ilium with diverticulum. Although the final diagnosis was MD, the test was a false positive since the MD did not contain ectopic gastric mucosa. False positive cases have been reported in the detection of ectopic gastric mucosa with abdominal scintigraphy with 99mTc-pertechnetate due to inflammatory processes such as diverticulitis.
References 1. Emamian SA, Shalaby-Rana E, Majd M. The spectrum of heterotopic gastric mucosa in children detected by Tc-99m pertechnetate scintigraphy. Clin Nucl Med. 2001;26:529-35.
2. Swaniker F, Soldes O, Hirschl RB. The utility of technetium 99m pertechnetate scintigraphy in the evaluation of patients with Meckel’s diverticulum. J Pediatr Surg. 1999;34:760-4. discussion 765. 3. Howarth DM. The role of nuclear medicine in the detection of acute gastrointestinal bleeding. Semin Nucl Med. 2006;36:133-46.
Image of interest
False positive in the detection of ectopic gastric mucosa in 99mTc-pertechnetate abdominal scintigraphy Falso positivo en la detección de mucosa gástrica ectópica en la gammagrafía abdominal con Tc99m-pertecnetato A. Santiago Chinchilla *, C. Ramos-Font, H. Palacios Gerona, M. Moreno Caballero, A.C. Rebollo Aguirre and J.M. Llamas Elvira Servicio de Medicina Nuclear, Hospital Universitario Virgen de las Nieves, Granada, Spain
information on the article
History of the article: Received: May 18, 2010 Accepted: June 9, 2010
A 12-year-old male was admitted for rectorrhagias. Abdominal scintigraphy with 99mTc-pertechnetate was requested for clinical suspicion of Meckel diverticulum (MD). Early phases of the study showed supravesical foci simultaneous to gastric activity which persisted in late images but of lesser uptake intensity than that of the stomach (fig. 1). Given the slight intensity, images were obtained in posterior projection although MD is usually visualized in anterior projection in the inferior hemiabdomen.1,2 The study showed the
same foci but with a similar intensity of gastric mucosa (fig. 2) being interpreted as positive for MD. The patient underwent surgery with complete resection of the diverticulum. The result was complicated MD with diverticulitis without ectopic gastric mucosa. False positive cases have been reported in the detection of ectopic gastric mucosa with abdominal scintigraphy with 99mTcpertechnetate due to inflammatory processes such as diverticulitis.3
Figure 1. Abdominal scintigraphy with an intravenous bolus of 99mTc-pertechnetate (185 mBq [5 mCi]). A) Early anterior projection (25 min). B) Late anterior projections (45 and 60 min.). The sequential images obtained during the first 25 minutes of examination show the appearance of foci simultaneous to gastric mucosa activity but of lesser intensity situated in the medial line above the urinary bladder which displaced toward the right iliac fossa on urination and persisted in the late images. The slight intensity of the foci did not allow the study to be considered completely positive leading to the performance of posterior projections for better visualization.
* Corresponding author. E-mail address: [email protected], [email protected] (A. Santiago Chinchilla). 0212-6982/$ - see front matter © 2010 Elsevier España, S.L. and SEMNIM. All rights reserved.
A. Santiago Chinchilla et al / Rev Esp Med Nucl. 2010;29(6):310-311
311
Figure 2. Abdominal scintigraphy with an intravenous bolus of 99mTc-pertechnetate (185 mBq [5 mCi]). A,B) Late posterior projections (45 and 60 min.). The posterior projections demonstrated the foci with greater clarity and with an intensity similar to that of the gastric mucosa at a right posterior supravesical level showing positivity for MD and leading to surgery with complete resection of the ilium with diverticulum. Although the final diagnosis was MD, the test was a false positive since the MD did not contain ectopic gastric mucosa. False positive cases have been reported in the detection of ectopic gastric mucosa with abdominal scintigraphy with 99mTc-pertechnetate due to inflammatory processes such as diverticulitis.
References 1. Emamian SA, Shalaby-Rana E, Majd M. The spectrum of heterotopic gastric mucosa in children detected by Tc-99m pertechnetate scintigraphy. Clin Nucl Med. 2001;26:529-35.
2. Swaniker F, Soldes O, Hirschl RB. The utility of technetium 99m pertechnetate scintigraphy in the evaluation of patients with Meckel’s diverticulum. J Pediatr Surg. 1999;34:760-4. discussion 765. 3. Howarth DM. The role of nuclear medicine in the detection of acute gastrointestinal bleeding. Semin Nucl Med. 2006;36:133-46.