The Application Value of MSCT in the Diagnosis of Meckel's Diverticulum in Children

Introduction Meckel's diverticulum (MD), the most prevalent congenital gastrointestinal malformation in children, often mimics acute abdominal conditions such as appendicitis and intussusception due to overlapping clinical presentations, leading to preoperative misdiagnosis rates of 34-62%. This study aimed to evaluate the diagnostic utility of multi-slice spiral CT (MSCT) in pediatric MD and define optimal scanning protocols with imaging diagnostic criteria. Methods A retrospective analysis was conducted on 65 pediatric patients (51 males; 14 females) with surgically confirmed Meckel's diverticulum. These patients were stratified into three subgroups based on clinical presentation: asymptomatic (24.6%, n=16), bleeding-dominant (47.7%, n=31), and pain-dominant (27.7%, n=18). Imaging protocols included abdominal non-contrast CT (65/65, 100%) and contrast-enhanced CT (62/65, 95.4%). Diagnostic accuracy was assessed through systematic evaluation of imaging characteristics, with univariate analysis employed to identify key imaging determinants. Results The predominant clinical presentations of MD were gastrointestinal bleeding (47.7%, 31/65) and abdominal pain (27.7%, 18/65). The pain-dominant subgroup demonstrated a significantly higher complication rate than the bleeding-dominant subgroup (72.2% vs 35.5% , P=0.002). MSCT achieved an overall diagnostic accuracy of 63.1% (41/65), with three characteristic imaging findings: (1) pouch-like blind-end structures predominantly in the right abdomen (82.9%, 54/65) or subumbilical midline (9.8%, 6/65); (2) arterial-phase blood supply from the superior mesenteric artery ileal branch; (3) perilesional fat stranding (43.9%, 29/65). Univariate analysis revealed that arterial phase imaging significantly improved specificity to 95% (AUC 0.94, P<0.001). Conclusion The diagnostic accuracy of MSCT in pediatric MD is limited by insufficient anatomical delineation. However, implementing a triad-based imaging protocol—right lower quadrant blind pouch morphology, peri-lesional inflammation, and mesenteric branch enhancement during arterial phase—supplemented with thin-slice multiplanar reconstruction (≤1 mm) and delayed arterial scanning, significantly improves detection rates and enhances differential diagnosis of acute abdominal conditions.