Incidental possible diagnosis by <sup>18</sup>F-fluorocholine PET/CT of Meckel's diverticulum and potential pitfalls

Lih Kin Khor, Hoi Yin Loi, Arvind Kumar Sinha, Suat Jin Lu

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

A 61 years old man with a history of prostate cancer Gleason 3+4, treated with radical prostatectomy, underwent fluorine-18-fluorocholine positron emission tomography/computed tomography (<sup>18</sup>F-FCH PET/CT) imaging to investigate rising serum prostate specific antigen (PSA) levels. <sup>18</sup>F-FCH PET/CT showed a focus of linear increased uptake by a possible Meckel's diverticulum in the right hemi-pelvis, which was an incidental finding in this asymptomatic patient. Uptake of <sup>18</sup>F-FCH by Meckel's diverticulum has not been reported before and thus the mechanism of uptake has not been established. Two postulations may explain this uptake. First, since Meckel's diverticulum is a true diverticulum containing all layers of the intestinal wall, the uptake may be related to physiological bowel-related uptake. Second, the uptake may be due to heterotopic pancreatic tissue in Meckel's diverticulum, especially since the intensity of uptake we have noticed was similar to that of physiological pancreatic uptake. As <sup>18</sup>F-FCH PET/CT scan is often used for evaluating prostate cancer, <sup>18</sup>F-FCH uptake by Meckel's diverticulum in the pelvis or lower abdomen may be mistaken for tumor involvement/recurrence. The identification by imaging of Meckel's diverticulum relies on the identification of a blind ending tubular structure, arising from the distal ileum. The identification of this structure may be best appreciated on the axial, coronal or sagittal plane. Conclusion: In this particular case, we managed to clearly demonstrate the presence of a tubular blind ending structure arising from the distal ileum on the sagittal images. The careful identification of this structure indicated that tracer uptake was in a Meckel's diverticulum and not within a pelvic lymph node or pelvic organ hence excluding recurrent disease.

Original languageEnglish
Pages (from-to)157-159
Number of pages3
JournalHellenic Journal of Nuclear Medicine
Volume18
Issue number2
Publication statusPublished - 1 Jun 2015
Externally publishedYes

Fingerprint

Meckel Diverticulum
Pelvis
Ileum
Prostatic Neoplasms
Choristoma
Incidental Findings
Fluorine
Diverticulum
Prostate-Specific Antigen
Prostatectomy
fluorocholine
Abdomen
Lymph Nodes
Recurrence
Serum

Keywords

  • <sup>18</sup>F-fluorocholine positron emission tomography/computed tomography (F-18-FCH PET/CT)
  • Heterotopic pancreatic tissue
  • Meckel's diverticulum
  • Prostate cancer
  • Prostate specific antigen

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Incidental possible diagnosis by <sup>18</sup>F-fluorocholine PET/CT of Meckel's diverticulum and potential pitfalls. / Khor, Lih Kin; Loi, Hoi Yin; Sinha, Arvind Kumar; Lu, Suat Jin.

In: Hellenic Journal of Nuclear Medicine, Vol. 18, No. 2, 01.06.2015, p. 157-159.

Research output: Contribution to journalArticle

Khor, Lih Kin ; Loi, Hoi Yin ; Sinha, Arvind Kumar ; Lu, Suat Jin. / Incidental possible diagnosis by <sup>18</sup>F-fluorocholine PET/CT of Meckel's diverticulum and potential pitfalls. In: Hellenic Journal of Nuclear Medicine. 2015 ; Vol. 18, No. 2. pp. 157-159.
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abstract = "A 61 years old man with a history of prostate cancer Gleason 3+4, treated with radical prostatectomy, underwent fluorine-18-fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT) imaging to investigate rising serum prostate specific antigen (PSA) levels. 18F-FCH PET/CT showed a focus of linear increased uptake by a possible Meckel's diverticulum in the right hemi-pelvis, which was an incidental finding in this asymptomatic patient. Uptake of 18F-FCH by Meckel's diverticulum has not been reported before and thus the mechanism of uptake has not been established. Two postulations may explain this uptake. First, since Meckel's diverticulum is a true diverticulum containing all layers of the intestinal wall, the uptake may be related to physiological bowel-related uptake. Second, the uptake may be due to heterotopic pancreatic tissue in Meckel's diverticulum, especially since the intensity of uptake we have noticed was similar to that of physiological pancreatic uptake. As 18F-FCH PET/CT scan is often used for evaluating prostate cancer, 18F-FCH uptake by Meckel's diverticulum in the pelvis or lower abdomen may be mistaken for tumor involvement/recurrence. The identification by imaging of Meckel's diverticulum relies on the identification of a blind ending tubular structure, arising from the distal ileum. The identification of this structure may be best appreciated on the axial, coronal or sagittal plane. Conclusion: In this particular case, we managed to clearly demonstrate the presence of a tubular blind ending structure arising from the distal ileum on the sagittal images. The careful identification of this structure indicated that tracer uptake was in a Meckel's diverticulum and not within a pelvic lymph node or pelvic organ hence excluding recurrent disease.",
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AB - A 61 years old man with a history of prostate cancer Gleason 3+4, treated with radical prostatectomy, underwent fluorine-18-fluorocholine positron emission tomography/computed tomography (18F-FCH PET/CT) imaging to investigate rising serum prostate specific antigen (PSA) levels. 18F-FCH PET/CT showed a focus of linear increased uptake by a possible Meckel's diverticulum in the right hemi-pelvis, which was an incidental finding in this asymptomatic patient. Uptake of 18F-FCH by Meckel's diverticulum has not been reported before and thus the mechanism of uptake has not been established. Two postulations may explain this uptake. First, since Meckel's diverticulum is a true diverticulum containing all layers of the intestinal wall, the uptake may be related to physiological bowel-related uptake. Second, the uptake may be due to heterotopic pancreatic tissue in Meckel's diverticulum, especially since the intensity of uptake we have noticed was similar to that of physiological pancreatic uptake. As 18F-FCH PET/CT scan is often used for evaluating prostate cancer, 18F-FCH uptake by Meckel's diverticulum in the pelvis or lower abdomen may be mistaken for tumor involvement/recurrence. The identification by imaging of Meckel's diverticulum relies on the identification of a blind ending tubular structure, arising from the distal ileum. The identification of this structure may be best appreciated on the axial, coronal or sagittal plane. Conclusion: In this particular case, we managed to clearly demonstrate the presence of a tubular blind ending structure arising from the distal ileum on the sagittal images. The careful identification of this structure indicated that tracer uptake was in a Meckel's diverticulum and not within a pelvic lymph node or pelvic organ hence excluding recurrent disease.

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KW - Prostate specific antigen

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