MR enterography for the diagnosis of symptomatic Meckel diverticulum in pediatric patients

Abstract

Objective To retrospectively investigate the value of MR enterography(MRE) for detecting symptomatic Meckel diverticulum(MD) in pediatric patients. Methods We retrospectively selected 16 patients from our MR database patients who underwent MRE between June 2014 and September 2015. They were referred for MRE because of suspected MD after negative or inconclusive upper sonography or scintigraphy or for exclusion diagnosis. There were 13 males and 3 females, with a median age of 2.2 years of age ranging from 0.4 to 8.2 years old. The first symptom included unexplained gastrointestinal bleeding, abdominal pain, small-bowel obstruction, intussusception, vomiting and fever. Two experienced radiologists determined the diverticulum's location, shape, contents and peripheral structural abnormalities. Results MD were diagnosed by MRE in all children. A total of 13 MD and 3 intestinal duplication cysts were pathologically confirmed. The diverticulum's location included: the right lower quadrant in 2 cases, around the navel in 4 cases, the left lower quadrant in 4 cases, the middle quadrant in 2 cases and pelvic cavity in 1 case. The diverticulum's presented as a blind-ending fluid-filled or gas-filled structure in 11 cases and a solid-appearing mass in 2 cases. The wall of the diverticulum showed restricted diffusion, increased mural enhancement comparable with that of adjacent small bowel in 12 cases, and interruption of the wall continuity in 1 case. Hemorrhage in diverticulum appeared as hyperintensity on T1WI images and/or hypointensity on T2WI images in 2 cases. Extravasation of intravascular contrast medium into the gastrointestinal tract due to active bleeding from a Meckel diverticulum was detected in 2 cases. Peripheral structural abnormalities included soft-tissue stranding, adjacent mesenteric stranding and enhancement, free fluid, small-bowel obstruction and enlarged lymph nodes. Conclusion MRE may play an important role in the diagnosis of suspected symptomatic Meckel diverticula, particularly given its lack of ionizing radiation. Key words: Meckel diverticulum; Child; Magnetic resonance imaging