Meckel's diverticulum diagnostic study of choice: Difference between revisions

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== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


===== Template statements =====
'''Technetium-99m pertechnetate  radioisotope scanning'''
 
* September 2014: Guidelines for the [[Nuclear medicine|Scintigraphy]] for Meckel’s diverticulum were laid down by:<ref name="pmid24948825">{{cite journal |vauthors=Spottswood SE, Pfluger T, Bartold SP, Brandon D, Burchell N, Delbeke D, Fink-Bennett DM, Hodges PK, Jolles PR, Lassmann M, Maurer AH, Seabold JE, Stabin MG, Treves ST, Vlajkovic M |title=SNMMI and EANM practice guideline for meckel diverticulum scintigraphy 2.0 |journal=J Nucl Med Technol |volume=42 |issue=3 |pages=163–9 |year=2014 |pmid=24948825 |doi=10.2967/jnmt.113.136242 |url=}}</ref>
=== Gold standard/Study of choice: ===
** Society of Nuclear Medicine and Molecular Imaging (SNMMI)
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
** European Association for Nuclear Medicine (EANM)
* The following result of [gold standard test] is confirmatory of [disease name]:
* [[Technetium-99m|Technetium-99m pertechnetate scanning]] helps in the detection of a symptomatic [[bleeding]] Meckel’s diverticulum.  
** Result 1
* It is preferred as the investigation of choice for the diagnosis of Meckel's diverticula in children due to the following features:<ref name="urlFundamentals of Pediatric Surgery - Google Books">{{cite web |url=https://books.google.com/books?id=-AAD9WiIZLAC&pg=PA773&lpg=PA773&dq=Mattei,+P.+(2011).+Fundamentals+of+Pediatric+Surgery.+New+York,+NY:+Springer+Science%2BBusiness+Media,+LLC.&source=bl&ots=VWeSV7HsOo&sig=p2LET6NVySpB-ANSdF3G1YmAzw8&hl=en&sa=X&ved=0ahUKEwip4uPoya3YAhUG_IMKHUn8ABIQ6AEIQTAD#v=onepage&q=Mattei%2C%20P.%20(2011).%20Fundamentals%20of%20Pediatric%20Surgery.%20New%20York%2C%20NY%3A%20Springer%20Science%2BBusiness%20Media%2C%20LLC.&f=false |title=Fundamentals of Pediatric Surgery - Google Books |format= |work= |accessdate=}}</ref>
** Result 2
** High accuracy
* The [name of investigation] should be performed when:
** [[Non-invasive (medical)|Noninvasive]] nature
** The patient presented with symptoms/signs 1. 2, 3.
** 95% [[Specificity (tests)|specificity]]
** A positive [test] is detected in the patient.
** 85% [[Sensitivity (tests)|sensitivity]]
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
** Approximately 50% of symptomatic Meckel's diverticula have [[Ectopia|ectopic]] [[Stomach|gastric]] or [[Pancreas|pancreatic cells]] contained within them<ref name="pmid10706156">{{cite journal |vauthors=Martin JP, Connor PD, Charles K |title=Meckel's diverticulum |journal=Am Fam Physician |volume=61 |issue=4 |pages=1037–42, 1044 |year=2000 |pmid=10706156 |doi= |url=}}</ref>
* The diagnostic study of choice for [disease name] is [name of investigation].
* [[Technetium-99m|Technetium-99m pertechnetate scanning]] is not preferred in adults as [[Type I and type II errors|false negative]] rates are high with [[Specificity (tests)|specificity]] of 9% and [[Sensitivity (tests)|sensitivity]] of 62%.
* There is no single diagnostic study of choice for the diagnosis of [disease name].  
* Indications of Meckel's scan:<ref name="pmid12540005">{{cite journal |vauthors=Lin S, Suhocki PV, Ludwig KA, Shetzline MA |title=Gastrointestinal bleeding in adult patients with Meckel's diverticulum: the role of technetium 99m pertechnetate scan |journal=South. Med. J. |volume=95 |issue=11 |pages=1338–41 |year=2002 |pmid=12540005 |doi= |url=}}</ref><ref name="pmid23417523">{{cite journal |vauthors=Sinha CK, Pallewatte A, Easty M, De Coppi P, Pierro A, Misra D, Biassoni L |title=Meckel's scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years |journal=Pediatr. Surg. Int. |volume=29 |issue=5 |pages=511–7 |year=2013 |pmid=23417523 |doi=10.1007/s00383-013-3270-3 |url=}}</ref>
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
** Patients with intermittent or less severe GI [[Bleeding|bleed]]  
* [Disease name] is mainly diagnosed based on clinical presentation.
** High suspicion of Meckel’s diverticulum
* Investigations:
** Failure to identify source of [[Bleeding|bleed]]
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* [[Type I and type II errors|False-positives]] are seen in the following conditions:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** [[Intussusception]]  
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
** [[Volvulus]]
 
** [[Obstruction]] of the [[small intestine]]
==== The comparison table for diagnostic studies of choice for [disease name] ====
** [[Appendicitis|Acute appendicitis]]
{|
** [[Carcinoid Tumor|Carcinoid]] of the [[Vermiform appendix|appendix]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
** [[Carcinoma]] of the [[cecum]]
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
* On [[Intravenous therapy|intravenous]] administration, the [[Technetium-99m|Technetium-99m pertechnate radioisotope]] is taken up by the [[gastric mucosa]].<ref name="pmid15241619">{{cite journal |vauthors=Rerksuppaphol S, Hutson JM, Oliver MR |title=Ranitidine-enhanced 99mtechnetium pertechnetate imaging in children improves the sensitivity of identifying heterotopic gastric mucosa in Meckel's diverticulum |journal=Pediatr. Surg. Int. |volume=20 |issue=5 |pages=323–5 |year=2004 |pmid=15241619 |doi=10.1007/s00383-004-1189-4 |url=}}</ref>
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
* In order to obtain a positive result, atleast 1.8 cm2 of [[Ectopia|ectopic]] [[gastric mucosa]] in Meckel's diverticulum is required.
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
* A Meckel's diverticulum containing [[gastric mucosa]] manifests as a small rounded area of increased activity in the right lower quadrant.
|-
* Normal activity simultaneously appears in the [[stomach]].
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
* [[Technetium-99m|Technetium-99m pertechnetate scanning]] requires 30 images, taken at 1-minute intervals to demonstrate [[terminal ileum]] activity.
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
* The use of [[Pentagastrin]] in [[Technetium-99m|Technetium-99m pertechnetate scanning]] has a synergistic effect:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
* Role of [[Pentagastrin]]:
|-
** [[Histamine receptor|Histamine-2 (H2) receptor blocker]]
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
** Enhances radioisotope uptake by the [[Cell (biology)|cells]]:
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
*** Promotes [[isotope]] retention
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
*** Blocks intraluminal release of [[isotope]]
|}
*** Minimizes [[Type I and type II errors|false negative]] results
<small> ✔= The best test based on the feature </small>
* Agents promoting retention of [[Technetium-99|99m technetium pertechnetate]]:<ref name="pmid729309">{{cite journal |vauthors=Petrokubi RJ, Baum S, Rohrer GV |title=Cimetidine administration resulting in improved pertechnetate imaging of Meckel's diverticulum |journal=Clin Nucl Med |volume=3 |issue=10 |pages=385–8 |year=1978 |pmid=729309 |doi= |url=}}</ref>
 
** [[Aluminium hydroxide|Aluminum hydroxide]]  
===== Diagnostic results =====
** [[Ranitidine]], Cimetidine
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:  
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].
 


==References==
==References==
* References should be cited for the material that you have put on your page. Type in <nowiki>{{reflist|2}}</nowiki>.This will generate your references in small font, in two columns, with links to the original article and abstract.
* References should be cited for the material that you have put on your page. Type in <nowiki>{{reflist|2}}</nowiki>.This will generate your references in small font, in two columns, with links to the original article and abstract.
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* For information on how to add references into your page, click [[Adding References to Articles|here]].

Revision as of 16:42, 2 January 2018


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

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Overview

  • The page name should be "[Disease name] diagnostic study of choice", with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
  • Goal:
    • To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].
    • To describe the gold standard test for the diagnosis of [disease name].
    • To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
  • As with all microchapter pages linking to the main page, at the top of the edit box put {{CMG}}, your name template, and the microchapter navigation template you created at the beginning.
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  • Remember to follow the same format and capitalization of letters as outlined in the template below.
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Diagnostic Study of Choice

Technetium-99m pertechnetate radioisotope scanning

References

  • References should be cited for the material that you have put on your page. Type in {{reflist|2}}.This will generate your references in small font, in two columns, with links to the original article and abstract.
  • For information on how to add references into your page, click here.
  1. ↑ Spottswood SE, Pfluger T, Bartold SP, Brandon D, Burchell N, Delbeke D, Fink-Bennett DM, Hodges PK, Jolles PR, Lassmann M, Maurer AH, Seabold JE, Stabin MG, Treves ST, Vlajkovic M (2014). "SNMMI and EANM practice guideline for meckel diverticulum scintigraphy 2.0". J Nucl Med Technol. 42 (3): 163–9. doi:10.2967/jnmt.113.136242. PMID 24948825.
  2. ↑ "Fundamentals of Pediatric Surgery - Google Books".
  3. ↑ Martin JP, Connor PD, Charles K (2000). "Meckel's diverticulum". Am Fam Physician. 61 (4): 1037–42, 1044. PMID 10706156.
  4. ↑ Lin S, Suhocki PV, Ludwig KA, Shetzline MA (2002). "Gastrointestinal bleeding in adult patients with Meckel's diverticulum: the role of technetium 99m pertechnetate scan". South. Med. J. 95 (11): 1338–41. PMID 12540005.
  5. ↑ Sinha CK, Pallewatte A, Easty M, De Coppi P, Pierro A, Misra D, Biassoni L (2013). "Meckel's scan in children: a review of 183 cases referred to two paediatric surgery specialist centres over 18 years". Pediatr. Surg. Int. 29 (5): 511–7. doi:10.1007/s00383-013-3270-3. PMID 23417523.
  6. ↑ Rerksuppaphol S, Hutson JM, Oliver MR (2004). "Ranitidine-enhanced 99mtechnetium pertechnetate imaging in children improves the sensitivity of identifying heterotopic gastric mucosa in Meckel's diverticulum". Pediatr. Surg. Int. 20 (5): 323–5. doi:10.1007/s00383-004-1189-4. PMID 15241619.
  7. ↑ Petrokubi RJ, Baum S, Rohrer GV (1978). "Cimetidine administration resulting in improved pertechnetate imaging of Meckel's diverticulum". Clin Nucl Med. 3 (10): 385–8. PMID 729309.
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