Intestines

• Meckel Diverticulum is caused by genetic defects in which a pouch is present in the mucosa of the small intestine and is able to accumulate Na99mTcO4.
• Merkel diverticulum scintigraphy priniciple

  diagnostic imaging procedure that detects the abnormally located gastric mucosa
• what Rf is used in Merkel diverticulum scintigraphy?

  99mTc pertechnetate
• Merkel diverticulum scintigraphy procedure

  • Fasting before procedure
  • IV administration of RF dose 150 MBq
  • Dynamic record of 30-40 minutes with 1-4 sequential scintigrams after 30 mins
  • Entire abdomen is shown in image with a frontal projection
  • SPECT can be used if suspected diverticuli is seen as late scan
• results of merkel diverticulum scintigraphy?

  • norm = mucosa + Rf excretion by kidney
  • atypical = increased accumulation of Rf in abnormal position
• intestinal bleeding scan principle?

  method to help detect the origin of GI bleeding by checking erythrocytes using the 99mTc activity remaining in the blood for as long as the RF decays (around 4 hours)
• what Rf is used in intestinal bleeding scan?

  99mTc RBC
• intestinal bleeding scan procedure

  • In vitro labelling of red blood cells
  • IV administration of Sn+(tin) ions in unlabelled MDP
  • 15 min after, collection of blood in syringe with 99mTcO4 (pertechnetate)àincubation
  • Administration of 500 MBq of 99mTc-RBC
  • Dynamic record of 30-40 minutes (1image/sec)
  • Initial SPECT to assess vascular space
  • If bleeding is not visualized, take one image each half an hour (2-5min/image)
  • Patient has to eat and move
  • Repeat until suspicious activity and repeat SPECT
• what is intestinal permeability?

  how easily substances pass through the intestinal wall.
• SCINTIGRAPHY OF INTESTINAL PERMEABILITY IMPAIRMENT principle?

  After IV application of 99mTc HSA (human serum albumin), the RF normally doesn’t leave the vessels. In case of hyperpermeability, the HAS can be found in the intestinal lumen
• what Rf is used in SCINTIGRAPHY OF INTESTINAL PERMEABILITY IMPAIRMENT?

  99mTc HSA (human serum albumin)
• SCINTIGRAPHY OF INTESTINAL PERMEABILITY IMPAIRMENT procedure?

  • IV administration of 740 MBq of 99mTc-Albumin
  • Short dynamic study
  • Serial images at minutes 10,30, 60, 120, 240 to 24 hours
  • Quantification of activity over the abdomen during time
• What are the causes of intestinal permeability impairment?

  • Inflamatory bowel disease
  • Idiopatic ulcerative jejunoileitis Infections (secondary obstruction)
  • Neoplasms (secondary obstruction)
  • Coeliac disease
• Bleeding in the upper gastrointestinal tract is easily accessible for what?

  fiberscope
• Main diagnoses that cause bleeding in the gastrointestinal tract

  • Cancer of small intestine
  • Colon cancer
  • Crohn’s disease