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

The Application Value of MSCT in the Diagnosis of Meckel's Diverticulum in Children | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Application Value of MSCT in the Diagnosis of Meckel's Diverticulum in Children wenjing huang, Huiying Wu, Xiaorui Zhao, Wenli Lai, Dongzhi He, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6721602/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract 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. Children Meckel's diverticulum CT Diagnostic value Figures Figure 1 Figure 2 Figure 3 Introduction Meckel's diverticulum (MD), the most prevalent congenital gastrointestinal malformation in children (incidence 2–3%), manifests with nonspecific symptoms including abdominal pain, gastrointestinal bleeding, and intestinal obstruction. These presentations are clinically indistinguishable from common acute abdominal conditions such as appendicitis and intussusception, leading to preoperative misdiagnosis rates of 34–62% [ 1 ] . Current diagnostic imaging modalities face significant limitations: Technetium-99m scintigraphy, despite demonstrating 85% sensitivity for detecting ectopic gastric mucosa [ 2 ] , is hampered by prolonged examination time (> 60 minutes), ionizing radiation exposure, and false-negative rates exceeding 40% in cases lacking ectopic mucosa [ 3 ] ;Ultrasound exhibits variable diagnostic accuracy (20–69%) due to operator dependency and intestinal gas interference [ 4 ] . Multi-slice spiral CT (MSCT), which combines high spatial resolution with multiphasic contrast enhancement, has emerged as the first-line imaging modality for pediatric acute abdomen [ 5 ] . However, its role in MD diagnosis remains debated, as prior studies predominantly focused on adult populations and have not systematically analyzed imaging features against surgicopathological confirmation [ 6 ] . This retrospective study of 65 surgically and pathologically confirmed pediatric MD cases aims to: 1) Establish MSCT diagnostic criteria specific to pediatric MD; 2) Quantify the impact of technical parameters on diagnostic accuracy; 3)Optimize MSCT protocols to establish an evidence-based strategy for reducing diagnostic errors. 1. Data and methods 1.1. A total of 65 cases of Meckel diverticulum (MD) in children diagnosed by surgery and pathology from January 2018 to June 2023 were retrospectively included. Inclusion criteria: ① Age ≤14 years old; The whole abdomen CT examination was completed before operation and the image data were complete; ③ There were no other digestive tract malformations or neoplastic diseases. Exclusion criteria: ① No CT examination was performed before emergency operation. Demographic characteristics (age, sex), clinical symptoms (abdominal pain, gastrointestinal bleeding), laboratory indicators (hemoglobin, white blood cell count), surgical records (operation type, diverticulum location, and complications), and pathological findings (ectopic tissue type) were collected. This study was approved by the Ethics Committee of the hospital (approval number: Suifu 'er Kelun 321A01) without the exemption of informed consent. 1.2 Examination Method All the children underwent 64-slice spiral CT full abdominal plain scan (Toshiba Aquilion/Philips Brilliance) before surgery, and 62 of them (95.4%) underwent enhanced scan. Fasting for 4 hours before examination was followed by oral sedation of 10% chloral hydrate (0.5 ml/kg) in children under 4 years of age. Scanning parameters: Tube voltage 120 kV, tube current automatic modulation, layer thickness 0.625mm, pitch 1.0, matrix 512×512, scanning range from the apex of diaphragm to the lower margin of symphysis pubis. The enhanced scan was performed by intravenous injection of iohexyl alcohol (dose 1.0-3.0 ml/kg, flow rate 1-2 ml/s) through the anterior cubital vein, using mass injection in arterial/venous phase (21-23/55-58 s). The original data were reconstructed by 0.625 mm thin layer and then processed by multiplane recombination (MPR) and volume reconstruction (VR). 1.3 Image Analysis Two radiologists with more than 10 years of experience in pediatric imaging diagnosis were used to independently evaluate the images by double-blind method, and the differences were reached through negotiation. Evaluation contents: Direct signs: diverticulum position (distance from ileocecal flap, quadrant distribution), maximum length diameter/tube diameter, wall thickness (thickest axial position), boundary definition, content density (gas/liquid/fat), degree of reinforcement (equal/low/high reinforcement compared with adjacent intestinal wall); Indirect signs: turbidity in the surrounding fat space, mesenteric lymph node enlargement (short diameter ≥ 5 mm), intestinal obstruction (migration zone, intestinal dilatation); Complications: intussusception (target or concentric signs), perforation of the intestine (free gas or encapsulated effusion). 1.4 Data Analysis SPSS 25.0 was used for data analysis, and P < 0.05 was considered statistically significant. The measurement data (age, disease course, diverticular size) were expressed as mean ± standard deviation (normal) or median/quartile distance (non-normal); And counting data (sex, degree of anemia, and presence or absence of ectopic tissue) were described in frequency (percentage, %). According to clinical symptoms, they were divided into asymptomatic group, abdominal pain group and bleeding group. Comparison between groups was as follows: ① Categorical variables (gender, anemia grade, etc.) were tested by Chi-square test or Fisher exact test; ② non-normal distributional variables (age, course of disease, etc.) were measured by Kruskal-Wallis H test. Univariate Logistic regression was used to analyze the relationship between CT signs and diagnostic coincidence rate, and the optimal diagnostic threshold (maximum Youden index) was determined by receiver operating characteristic curve (ROC). Finally, single factor analysis was used to compare the detection rate of MSCT for diagnostic MD, and the sensitivity, specificity, best threshold value and area under the surface (AUC) were calculated. 2. Results 2.1 General Information A total of 65 children with surgically diagnosed MD were included in this study, including 51 males (78.5%) and 14 females (21.5%), with a male to female ratio of 3.6:1. The median age was 4 years (IQR:7 years; Range: January-13 years). The main clinical manifestations were gastrointestinal bleeding (47.7%, 31/65) and abdominal pain (27.7%, 18/65), 27.7% (18/65) combined with intestinal obstruction (13.8%, 9/65), intussusception (12.3%, 8/65), diverticulitis (7.7%, 5/65), intestinal volvulus (6.2%, 4/65) and other complications. The main surgical methods were laparoscopic resection (76.9%, 50/65). The mean distance between diverticulum and ileocecal valve was (42.70±19.74) cm (range: 15~120 cm). The detection rate of ectopic tissue was 64.6% (42/65), mainly gastric mucosa (85.7%, 36/42), followed by pancreatic mucosa (11.9%, 5/42). According to the clinical manifestations, they were divided into three groups: asymptomatic group(n=16,24.6%) : intraoperative detection or accidental imaging detection; Bleeding group (n=31,47.7%) : blood stool/black stool as the main manifestation, accompanied by anemia (hemoglobin <110 g/L); Abdominal pain group (n= 18,27.7%) : no definite bleeding history, acute/chronic abdominal pain. There were no significant differences in gender (P=0.315), age (P=0.125), maximum lesion diameter (P=0.829), white blood cell count (P=0.113) and ectopic tissue distribution (P=0.334) among the three groups (Table 1). There were statistically significant differences in the course of disease (P=0.046), degree of anemia (P<0.001) and incidence of complications (P=0.001). The Bonferroni-adjusted pairwise comparison showed that the median course of disease was longer in the bleeding group than in the abdominal pain group (0.50 months vs 0.12 months, P=0.004) and asymptomatic group (0.50 months vs 0.03 months, P<0.001). 93.5% (29/31) of bleeding group were accompanied by anemia(Hb=76.97±20.13g/L),moderate to severe anemia accounted for 74.2%(23/31),and 96.8%(30/31) needed blood transfution support. The incidence of complications in the abdominal pain group(72.2%,13/18) was significantly higher than that in the bleeding group(35.5%,11/31,p=0.003) and asymptomatic group(12.5%,2/16,p<0.001). Table 1. Comparison of clinical features of MD in children in 3 group3(n=65) Asymptomatic group(n=16) Bleeding group(n=31) Abdominal pain group(n=18) P Gender(M%) 2 87.5% (14) 80.6% (25) 66.7% (12) 0.315 Age(year)/M/IRS 1 2.50/6.08 5.00/7.70 5.50/6.25 0.125 Duration of disease(month)/M/IRS 1 0.03/* b 0.50/1.87 a 0.12/0.26 a,b 0.006 # Lesion(cm)/M/IRS 1 1.50/2.70 1.50/0.80 1.50/0.77 0.829 Anemia 2 No 93.7%（15） 6.5%（2） 94.4%（17） 0.000 # Light 6.3%（1） a 19.4%（6） b 5.6%（1） a Moderate 0 45.2%（14） 0 Heavy 0 28.9%（9） 0 White blood cells 2 Normal 87.5%（14） 61.35%（19） 72.2%（13） 0.113 up 12.5%（2） 22.6%（7） 27.8%（5） Ectopic tissue 2 no 43.8%（7） 25.8%（8） 44.4%（8） 0.334 stomach 50%（8） 61.3%（19） 50%（9） Pancreas 0 12.4%（4） 5.6%（1） Both 6.2%（1） 0 0 Complications 1 （+） 12.5%（2） a 35.5%（11） a 72.2%（13） b 0.002 # Note:1: Kruskal-Wallis H test; 2: chi-square test. #: p<0.05; M/IRS: median/quartile spacing; a, b represent subsets of the group categories whose column proportions do not differ significantly from each other at the 0.05 level 2.2 Application value of MSCT in pediatric MD All the children underwent whole-abdominal MSCT examination and 95.4% (62/65) underwent enhanced scan. The overall diagnosis coincidence rate of MSCT was 63.1% (41/65), and the misdiagnosis rate was 36.9% (24/65), among which 2 cases were misdiagnosed (intestinal duplication malformation combined with infection). In the negative group of 24 cases (24/65,36.9%), the length diameter of diverticulum measured during the operation was 3.24 ± 1.61cm, and the tube diameter was 1.59±0.86cm. 2.2.1 MD imaging findings ① Anatomical location: the abdomen was evenly divided into 4 quadrants, and if the diverticulum was located above/below the umbilicus, it was denoted as the midline area. The positive cases were 82.9% (34/41) in the right quadrant (70.7% in the right lower quadrant and 12.2% in the right upper quadrant), 9.8% (4/41) in the midline region, and 3 cases (7.3%) in the left lower quadrant. ② Diverticulum size: The length diameter measured by MSCT (M/IRS = 2.50/1.36cm) was smaller than that measured during the operation (M/IRS = 3.00/3.00cm, p=0.003). There was no significant difference in diameter between them (M/IRS = 2.00/1.05cm vs 1.50/0.80cm) (P=0.24). ③ Inflammatory changes(Figure 1): 31.7% (13/41) diverticulum wall thickness ≤2 mm, 51.2% (21/41) 2-5 mm, 17.1% (7/41) ≥5 mm; 43.9% (18/41) with peripheral adipose space blurring. ④ Diverticular contents: Gas accounted for 31.7% (13/41), fluid 48.8% (20/41), and fat density 14.6% (6/41) in positive cases. ⑤ Complication detection: The detection rate of MSCT was 22.0% (9/41) in positive group and 37.5% (9/24) in negative group. The detection rates of intussusception (14.6%, 6/41)(Figure 2) and intestinal obstruction (7.3%, 3/41) (Figure 3)in MSCT positive group were higher than those in negative group (8.3%, 2/24; 25.0%, 6/24), there was no significant difference (P =0.69, P =0.06). 2.2.2 Analysis of misdiagnosis factors The diagnostic accuracy rate of MSCT was 63.1% (41/65), and the miss/misdiagnosis rate was 36.9% (24/65), among which 2 cases were misdiagnosed with intestinal duplication malformation and infection. Unifactor analysis showed that six parameters were significantly correlated with the diagnostic coincidence rate (P < 0.05)(Table 2), including clinical dimension (anemia degree), image characteristics (intestinal wall thickness, content properties), and technical parameters (thin-layer reconstruction, multiplane recombination, and enhanced phase). Among them, enhanced phase sensitivity (92%) and specificity (95%) were the highest. Table 2. Analysis of factors influencing the initial detection rate of MD in children by MSCT(n=65) Detection rate(%) P Sensitivity Specificity Boundary value Cut-off AUC None（n＝24） Yes（ n＝41） Clinical Gender（male） 2 83.3%（20） 75.6%（31） 0.465 0.26 0.79 0.05 1 0.53 Age(years) 1% 8.28 5 0.701 0.68 0.53 0.21 3 0.53 Abdominal pain（+） 2 33.3%（8） 24.4%（10） 0.435 0 1 0 0 0.42 Anaemia（+） 2 25%（6） 61%（25） 0.031 # 0.61 0.63 0.24 0 0.62 Diverticulum length diameter 1 （cm） % 0.88 1 0.202 0.47 0.68 0.16 3.5 0.56 Image features Intestinal wall 2 ≤2mm 79.2%（19） 43.9%（18） 0.017 # 0.61 0.74 0.34 1 0.66 ＞2mm，≤5mm 12.5%（3） 43.9%（18） ＞5mm 8.3%（2） 12.2%（5） Around 2 Poor filling 41.7%（10） 42.5%（17） 0.74 0.61 0.47 0.08 1 0.53 Bowel dilatation 8.3%（2） 14.6%（6） Cloudy fat space（+） 50% (12) 43.9%（18） Contents 2 No 37.5%（9） 4.9%（2） 0.001 # 0.50 0.95 0.45 2 0.81 Liquid 58.3%（14） 48.8%（20） Gas 0 31.7%（13） Fat 4.2%（1） 14.6%（6） Technique Thin layer（+） 2 25%（6） 51.2%（21） 0.038 # 0.53 0.68 0.21 0 0.61 MRP（+） 2 25%（6） 51.2%（21） 0.038 # 0.53 0.68 0.21 0 0.61 Time phase 2 Arterial phase / 65.8%（27） 0.004 # 0.66 0.95 / / 0.94 Note:1：Mann-Whitney U test；2：Chi-square test; #：p<0.05;%: interquartile 3. Discussion 3.1 Clinical features and diagnosis and treatment implications The male-to-female ratio in this pediatric MD cohort was 3.6:1, aligning with the known embryological predisposition of vitelline duct anomalies in males. Gastrointestinal bleeding (47.7%, 31/65) and abdominal pain (27.7%, 18/65) predominated as clinical presentations, with asymptomatic cases accounting for 24.6% (16/65)--a proportion markedly higher than the 4.2%-6.4% reported in adult populations [ 7 ] . This discrepancy may reflect pediatric-specific selection bias or heightened symptomatic severity in children. Notably, the pain-dominant subgroup exhibited significantly higher complication rates than the bleeding-dominant subgroup (72.2%vs. 35.5%; P = 0.001), alongside shorter symptom duration (median: 0.12 vs. 0.50 months). These findings suggest that abdominal pain-type MD may serve as an early indicator of secondary intestinal obstruction or volvulus, warranting prompt surgical evaluation. The underlying pathology appears multifactorial: 1) Mechanical obstruction: Narrow diverticular necks promote content stasis, bacterial overgrowth, and localized inflammation [ 8 ] ; 2)Ectopic mucosa: Acid-secreting gastric tissue (identified in 85.7% of cases) elevates risks of ulceration and perforation [ 9 ] . The ectopic tissue detection rate in this cohort was 64.6% (42/65), marginally lower than literature-reported 80%-85% [ 9 ] . This gap likely stems from incomplete full-thickness histopathological sampling and oversight of microscopic ectopic foci [ 8 ] . Of particular note,93.5%(29/31)of bleeding-dominant cases presented with chronic anemia(hemoglobin:76.97 ± 20.13g/L),necessitating transfusion in 96.7%(30/31). These data underscore MD’s role as a critical etiology of occult pediatric gastrointestinal bleeding.We advocate for routine inclusion of MD in differential diagnoses for pediatric anemia of unknown origin,particularly in preschool-aged males. 3.2 Strategies for improving MSCT diagnostic efficacy This study provides the first systematic evaluation of MSCT for pediatric MD, demonstrating a diagnostic accuracy of 63.1%--surpassing ultrasound but remaining inferior to technetium-99m scintigraphy [ 3 , 9 ] . Among the 36.9% (24/65) of cases with missed/misdiagnosis, 62.5% (15/24) were asymptomatic and radiologically indistinguishable from normal bowel loops (79.2% showing ≤ 2 mm intestinal wall thickness ). These findings led to the proposal of a diagnostic MSCT triad:①Right lower quadrant blind pouch (82.9%, 54/65); ②Arterial-phase mesenteric branch vascularity from the superior mesenteric artery; ③Peri-diverticular fat stranding (43.9%, 29/65). Crucially, MSCT exhibited limitations in complication detection: while intussusception (14.6%, 9/65) and bowel obstruction (7.3%, 5/65) were identified in imaging-positive cases, 37.5% (9/24) of acute abdominal emergencies were missed in imaging-negative cohorts, primarily due to incomplete bowel assessment during urgent scans. To address these gaps, we propose an optimized protocol: 1)Anatomical tracing method: Retrograde tracing of the terminal ileum (60 cm from the ileocecal valve, covering MD-prone zones [ 10 ] ) using thin-slice multiplanar reconstruction (≤ 1 mm) to detect anti-mesenteric blind-end structures; 2) Phase selection: Prioritizing late arterial phase scans (sensitivity 92%, specificity 95%) to enhance visualization of MD-feeding vessels (persistent vitelline artery or ileocolic branches [ 11 ] ) while reducing radiation exposure from dual-phase protocols. 4. Limitations This study has several limitations: First, its single-center retrospective design introduces potential selection bias. Second, the absence of a healthy control cohort restricts the ability to establish specificity thresholds. Additionally, non-uniform enhancement protocols (4.6% [3/65] undergoing non-contrast CT alone) may have influenced diagnostic accuracy. Future multi-center prospective trials with standardized imaging protocols should be conducted to validate the generalizability of the proposed MSCT diagnostic criteria and refine complication detection strategies. 5. Conclusion Pediatric MD exhibits symptom-driven clinical heterogeneity: abdominal pain-dominant subtypes warrant urgent evaluation for acute complications, whereas bleeding-dominant presentations necessitate assessment for chronic anemia. While MSCT diagnostic accuracy is constrained by anatomical visualization challenges, ​optimizing imaging protocols–through the triad of right lower quadrant blind pouch morphology, peri-diverticular inflammation, and arterial-phase mesenteric vascularity, combined with thin-slice multiplanar reconstruction (≤ 1 mm) and late arterial phase enhancement–demonstrates potential to improve detection rates and guide differential diagnosis of acute abdomen while minimizing radiation exposure. Declarations Author Contribution Conceptualization: Wenjing Huang，Huiying Wu Data curation: Wenjing Huang，Xiaorui Zhao Formal analysis: Xiaorui Zhao，Dongzhi He Funding acquisition: Huiying Wu Investigation: Xiaorui Zhao, Xiaozhu Huang Methodology: Wenjing Huang Project administration: Wenli Lai, Yue XI Resources: Xiaozhu Huang, Wenli Lai Software: Dongzhi He, Yue XI Supervision: Yue XI，Xiaorui Zhao Validation: Huiying Wu Visualization: Dongzhi He Writing-original draft: Wenjing Huang, Xiaorui Zhao Writing-review & editing:Huiying Wu References Suh M, Lee HY, Jung K et al (2015) Diagnostic accuracy of meckel scan with initial hemoglobin level to detect symptomatic meckel diverticulum[J/OL]. Eur J Pediatr Surgery: Official J Austrian Association Pediatr Surg … et Al] = Z Fur Kinderchirurgie 25(5):449–453 Malik AA, Shams-ul-Bari, Wani KA et al (2010) Meckel’s diverticulum-revisited[J/OL]. Saudi J Gastroenterology: Official J Saudi Gastroenterol Association 16(1):3–7 Jj P, Bg W, Mk T et al (2005) Meckel diverticulum: the mayo clinic experience with 1476 patients (1950–2002)[J/OL]. Ann Surg 241(3)[2025-02-12]. Hansen CC, Søreide K (2018) Systematic review of epidemiology, presentation, and management of Meckel’s diverticulum in the 21st century[J/OL]. Medicine 97(35):e12154 Park JJ, Wolff BG, Tollefson MK et al (2005) Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950–2002)[J/OL]. Ann Surg 241(3):529–533 Platon A, Gervaz P, Becker CD et al (2010) Computed tomography of complicated meckel’s diverticulum in adults: a pictorial review[J/OL]. Insights into Imaging 1(2):53–61 Olson DE, Kim YW, Donnelly LF (2009) CT findings in children with meckel diverticulum[J/OL]. Pediatric Radiology. 39(7): 659–663; quiz 766–767 Manner H, May A, Nachbar L et al (2006) Push-and-pull enteroscopy using the double-balloon technique (double-balloon enteroscopy) for the diagnosis of meckel’s diverticulum in adult patients with GI bleeding of obscure origin[J/OL]. Am J Gastroenterol 101(5):1152–1154 Chen JJ, Lee HC, Yeung CY et al (2014) Meckel’s diverticulum: factors associated with clinical manifestations[J/OL]. ISRN gastroenterology. 2014: 390869 Rattan KN, Singh J, Dalal P et al (2016) Meckel’s diverticulum in children: our 12-year experience[J/OL]. Afr J Pediatr surgery: AJPS 13(4):170–174 Elsayes KM, Menias CO, Harvin HJ et al (2007) Imaging Manifestations of Meckel’s Diverticulum[J/OL]. Am J Roentgenol 189(1):81–88 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6721602","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471717131,"identity":"c3fe179c-6f2e-43cc-b4f2-d16f340b5503","order_by":0,"name":"wenjing huang","email":"","orcid":"","institution":"Department of Radiology,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou,510623,China","correspondingAuthor":false,"prefix":"","firstName":"wenjing","middleName":"","lastName":"huang","suffix":""},{"id":471717132,"identity":"9b871fae-ba84-4033-81cf-1e74e9cceb45","order_by":1,"name":"Huiying Wu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIie3RrwvCQBTA8SeKlocz3kD8Gy5NhYH/yhvCLApGg4oinEHt/hlG43DgytlPMLhi1mgRNwTjdlHwPu3gfblfAIbxgzgUZkAAaFXm8yuNXP2kbq/DkF+lr5N8uFz5vh2LQ37SZF3B4v0EuZTOiMoBWMsVZSbtrSeYJyO0o7WjCC/A5GmXfTCVJuKI1WQXRewGnA00E1B9Z0g81E7GWEuuD0Q6iYwXLU8EmD4yo8DH/LtEvfj8FNNO+pWP58ttWMtNdpIoMYDwu8K88VTxDjDVGTQMw/hXb8yWUtF3+2/hAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Radiology,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou,510623,China","correspondingAuthor":true,"prefix":"","firstName":"Huiying","middleName":"","lastName":"Wu","suffix":""},{"id":471717133,"identity":"62242b42-d354-49a2-8d0d-bf831767b4fc","order_by":2,"name":"Xiaorui Zhao","email":"","orcid":"","institution":"Department of Radiology,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou,510623,China","correspondingAuthor":false,"prefix":"","firstName":"Xiaorui","middleName":"","lastName":"Zhao","suffix":""},{"id":471717134,"identity":"e5a1c2f6-6361-4f2d-97ec-4afac244b368","order_by":3,"name":"Wenli Lai","email":"","orcid":"","institution":"Department of Radiology,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou,510623,China","correspondingAuthor":false,"prefix":"","firstName":"Wenli","middleName":"","lastName":"Lai","suffix":""},{"id":471717135,"identity":"cf55959a-487b-4a31-aeb4-7e38f705f575","order_by":4,"name":"Dongzhi He","email":"","orcid":"","institution":"Department of Radiology,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou,510623,China","correspondingAuthor":false,"prefix":"","firstName":"Dongzhi","middleName":"","lastName":"He","suffix":""},{"id":471717139,"identity":"12256bf2-417b-4742-9ab9-850cb8286077","order_by":5,"name":"Yue Xi","email":"","orcid":"","institution":"Department of Radiology,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou,510623,China","correspondingAuthor":false,"prefix":"","firstName":"Yue","middleName":"","lastName":"Xi","suffix":""}],"badges":[],"createdAt":"2025-05-22 06:08:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6721602/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6721602/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84873094,"identity":"fb780e43-d3ae-4966-93df-c0a7b96c6529","added_by":"auto","created_at":"2025-06-18 09:18:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":554810,"visible":true,"origin":"","legend":"\u003cp\u003eMale, 11 years old, with paroxysmal abdominal pain for 1 day. Figure 1A: Axial CT enhanced arterial phase shows thickening and strengthening of the left lower abdominal bowel (triangle) with a small amount of fluid in the diverticulum. Figure 1B: Coronal MPR reconstruction shows a symmetrical mesenteric bowel with a blind end (triangle), one side of which is attached to the intestinal lumen. Figure 1C: Coronary MRP identifies the lesion (triangle) as a mesenteric vessel supplying blood (white arrow). Figure 1D: Intraoperative confirmation of a diverticuloid projection of the ileum against the mesentery, protruding out of the intestinal lumen.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6721602/v1/1ded799ae5e235efd6ff9e12.png"},{"id":84874459,"identity":"348d9e28-f1b7-428d-b092-20ce6a5c7f4f","added_by":"auto","created_at":"2025-06-18 09:26:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":321004,"visible":true,"origin":"","legend":"\u003cp\u003eA 4-year-old female presented with intermittent abdominal pain for more than half q u e a month, aggravated for 1 day. MD was accompanied by pancreatic ectopic tissue and secondary intussusception. Figure 2A: Axial CT enhanced arterial phase showed thickening and swelling of the distal ileum wall, which was inserted into the end of the ileum in concentric circle shape. A nodular soft tissue shadow (white arrow) was seen in the lumen of part of the intestinal tube. Figure 2B, 2C: coronal and sagittal reconstruction of the mesenteric branch blood supply vessels.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6721602/v1/493d27802d10dc6103993591.png"},{"id":84874460,"identity":"d4548b1a-ce2e-40f2-9a25-88cb5a9e36cc","added_by":"auto","created_at":"2025-06-18 09:26:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":289693,"visible":true,"origin":"","legend":"\u003cp\u003eMale, 1 year old, 3 months old, recurrent vomiting for 3 days, MD and intestinal obstruction. Figure 3A: Axial CT scan shows diffuse dilatation of the abdominal bowel filled with fluid and gas. The center of the dilated bowel may be a long tube that is disconnected from the rest of the bowel. Figure 3B: Coronal view showing the left side of the bowel with the mesenteric vessels. Figure 3C: Sagittal view shows mainly fluid in the MD.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6721602/v1/80b01fc914303544bc9f2eda.png"},{"id":85203222,"identity":"5aeea0d9-52eb-438f-80cd-00b5b91bbf0d","added_by":"auto","created_at":"2025-06-23 10:53:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1799981,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6721602/v1/50c03a18-4fb3-4139-87e9-bc94c0a54d4c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Application Value of MSCT in the Diagnosis of Meckel's Diverticulum in Children","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMeckel's diverticulum (MD), the most prevalent congenital gastrointestinal malformation in children (incidence 2\u0026ndash;3%), manifests with nonspecific symptoms including abdominal pain, gastrointestinal bleeding, and intestinal obstruction. These presentations are clinically indistinguishable from common acute abdominal conditions such as appendicitis and intussusception, leading to preoperative misdiagnosis rates of 34\u0026ndash;62% \u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eCurrent diagnostic imaging modalities face significant limitations: Technetium-99m scintigraphy, despite demonstrating 85% sensitivity for detecting ectopic gastric mucosa \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, is hampered by prolonged examination time (\u0026gt;\u0026thinsp;60 minutes), ionizing radiation exposure, and false-negative rates exceeding 40% in cases lacking ectopic mucosa \u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e;Ultrasound exhibits variable diagnostic accuracy (20\u0026ndash;69%) due to operator dependency and intestinal gas interference \u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. Multi-slice spiral CT (MSCT), which combines high spatial resolution with multiphasic contrast enhancement, has emerged as the first-line imaging modality for pediatric acute abdomen \u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. However, its role in MD diagnosis remains debated, as prior studies predominantly focused on adult populations and have not systematically analyzed imaging features against surgicopathological confirmation \u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/sup\u003e. This retrospective study of 65 surgically and pathologically confirmed pediatric MD cases aims to: 1) Establish MSCT diagnostic criteria specific to pediatric MD; 2) Quantify the impact of technical parameters on diagnostic accuracy; 3)Optimize MSCT protocols to establish an evidence-based strategy for reducing diagnostic errors.\u003c/p\u003e"},{"header":"1. Data and methods","content":"\u003cp\u003e1.1. A total of 65 cases of Meckel diverticulum (MD) in children diagnosed by surgery and pathology from January 2018 to June 2023 were retrospectively included. Inclusion criteria:\u0026nbsp;①\u0026nbsp;Age ≤14 years old; The whole abdomen CT examination was completed before operation and the image data were complete;\u0026nbsp;③\u0026nbsp;There were no other digestive tract malformations or neoplastic diseases. Exclusion criteria:\u0026nbsp;①\u0026nbsp;No CT examination was performed before emergency operation. Demographic characteristics (age, sex), clinical symptoms (abdominal pain, gastrointestinal bleeding), laboratory indicators (hemoglobin, white blood cell count), surgical records (operation type, diverticulum location, and complications), and pathological findings (ectopic tissue type) were collected. This study was approved by the Ethics Committee of the hospital (approval number: Suifu 'er Kelun 321A01) without the exemption of informed consent.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.2 Examination Method\u003c/p\u003e\n\u003cp\u003eAll the children underwent 64-slice spiral CT full abdominal plain scan (Toshiba Aquilion/Philips Brilliance) before surgery, and 62 of them (95.4%) underwent enhanced scan. Fasting for 4 hours before examination was followed by oral sedation of 10% chloral hydrate (0.5 ml/kg) in children under 4 years of age. Scanning parameters: Tube voltage 120 kV, tube current automatic modulation, layer thickness 0.625mm, pitch 1.0, matrix 512×512, scanning range from the apex of diaphragm to the lower margin of symphysis pubis. The enhanced scan was performed by intravenous injection of iohexyl alcohol (dose 1.0-3.0 ml/kg, flow rate 1-2 ml/s) through the anterior cubital vein, using mass injection in arterial/venous phase (21-23/55-58 s). The original data were reconstructed by 0.625 mm thin layer and then processed by multiplane recombination (MPR) and volume reconstruction (VR).\u003c/p\u003e\n\u003cp\u003e1.3 Image Analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTwo radiologists with more than 10 years of experience in pediatric imaging diagnosis were used to independently evaluate the images by double-blind method, and the differences were reached through negotiation. Evaluation contents: Direct signs: diverticulum position (distance from ileocecal flap, quadrant distribution), maximum length diameter/tube diameter, wall thickness (thickest axial position), boundary definition, content density (gas/liquid/fat), degree of reinforcement (equal/low/high reinforcement compared with adjacent intestinal wall); Indirect signs: turbidity in the surrounding fat space, mesenteric lymph node enlargement (short diameter ≥ 5 mm), intestinal obstruction (migration zone, intestinal dilatation); Complications: intussusception (target or concentric signs), perforation of the intestine (free gas or encapsulated effusion).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.4 Data Analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSPSS 25.0 was used for data analysis, and P \u0026lt; 0.05 was considered statistically significant. The measurement data (age, disease course, diverticular size) were expressed as mean ± standard deviation (normal) or median/quartile distance (non-normal); And counting data (sex, degree of anemia, and presence or absence of ectopic tissue) were described in frequency (percentage, %). According to clinical symptoms, they were divided into asymptomatic group, abdominal pain group and bleeding group. Comparison between groups was as follows: ① Categorical variables (gender, anemia grade, etc.) were tested by Chi-square test or Fisher exact test; ② non-normal distributional variables (age, course of disease, etc.) were measured by Kruskal-Wallis H test. Univariate Logistic regression was used to analyze the relationship between CT signs and diagnostic coincidence rate, and the optimal diagnostic threshold (maximum Youden index) was determined by receiver operating characteristic curve (ROC). Finally, single factor analysis was used to compare the detection rate of MSCT for diagnostic MD, and the sensitivity, specificity, best threshold value and area under the surface (AUC) were calculated.\u003c/p\u003e"},{"header":"2. Results ","content":"\u003cp\u003e2.1 General Information\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA total of 65 children with surgically diagnosed MD were included in this study, including 51 males (78.5%) and 14 females (21.5%), with a male to female ratio of 3.6:1. The median age was 4 years (IQR:7 years; Range: January-13 years). The main clinical manifestations were gastrointestinal bleeding (47.7%, 31/65) and abdominal pain (27.7%, 18/65), 27.7% (18/65) combined with intestinal obstruction (13.8%, 9/65), intussusception (12.3%, 8/65), diverticulitis (7.7%, 5/65), intestinal volvulus (6.2%, 4/65) and other complications. The main surgical methods were laparoscopic resection (76.9%, 50/65). The mean distance between diverticulum and ileocecal valve was (42.70\u0026plusmn;19.74) cm (range: 15~120 cm). The detection rate of ectopic tissue was 64.6% (42/65), mainly gastric mucosa (85.7%, 36/42), followed by pancreatic mucosa (11.9%, 5/42).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the clinical manifestations, they were divided into three groups: asymptomatic group(n=16,24.6%) : intraoperative detection or accidental imaging detection; Bleeding group (n=31,47.7%) : blood stool/black stool as the main manifestation, accompanied by anemia (hemoglobin \u0026lt;110 g/L); Abdominal pain group (n= 18,27.7%) : no definite bleeding history, acute/chronic abdominal pain. There were no significant differences in gender (P=0.315), age (P=0.125), maximum lesion diameter (P=0.829), white blood cell count (P=0.113) and ectopic tissue distribution (P=0.334) among the three groups (Table 1). There were statistically significant differences in the course of disease (P=0.046), degree of anemia (P\u0026lt;0.001) and incidence of complications (P=0.001). The Bonferroni-adjusted pairwise comparison showed that the median course of disease was longer in the bleeding group than in the abdominal pain group (0.50 months vs 0.12 months, P=0.004) and asymptomatic group (0.50 months vs 0.03 months, P\u0026lt;0.001). 93.5% (29/31) of bleeding group were accompanied by anemia(Hb=76.97\u0026plusmn;20.13g/L),moderate to severe anemia accounted for 74.2%(23/31),and 96.8%(30/31) needed blood transfution support. The incidence of complications in the abdominal pain group(72.2%,13/18) was significantly higher than that in the bleeding group(35.5%,11/31,p=0.003) and asymptomatic group(12.5%,2/16,p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eTable 1.\u0026nbsp;Comparison of clinical features of MD in children in 3 group3(n=65)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003eAsymptomatic group(n=16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003eBleeding group(n=31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003eAbdominal pain group(n=18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eGender(M%)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e87.5% (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e80.6% (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e66.7% (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 321px;\"\u003e\n \u003cp\u003eAge(year)/M/IRS\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e2.50/6.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e5.00/7.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5.50/6.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eDuration of disease(month)/M/IRS\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0.03/* \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e0.50/1.87 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0.12/0.26 \u003csup\u003ea,b\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.006\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eLesion(cm)/M/IRS\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e1.50/2.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e1.50/0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1.50/0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.829\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAnemia\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e93.7%（15）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e6.5%（2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e94.4%（17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.000\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eLight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e6.3%（1）\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e19.4%（6）\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5.6%（1）\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e45.2%（14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eHeavy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e28.9%（9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003eWhite blood cells\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eNormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e87.5%（14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e61.35%（19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e72.2%（13）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.113\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e12.5%（2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e22.6%（7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e27.8%（5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 178px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEctopic tissue\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e43.8%（7）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e25.8%（8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e44.4%（8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.334\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003estomach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e50%（8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e61.3%（19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e50%（9）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003ePancreas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e12.4%（4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e5.6%（1）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003eBoth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e6.2%（1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 321px;\"\u003e\n \u003cp\u003eComplications\u003csup\u003e1\u003c/sup\u003e（+）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 166px;\"\u003e\n \u003cp\u003e12.5%（2）\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 191px;\"\u003e\n \u003cp\u003e35.5%（11）\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e72.2%（13）\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.002\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote:1: Kruskal-Wallis H test; 2: chi-square test. #: p\u0026lt;0.05; M/IRS: median/quartile spacing; a, b represent subsets of the group categories whose column proportions do not differ significantly from each other at the 0.05 level\u003c/p\u003e\n\u003cp\u003e2.2 Application value of MSCT in pediatric MD\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll the children underwent whole-abdominal MSCT examination and 95.4% (62/65) underwent enhanced scan. The overall diagnosis coincidence rate of MSCT was 63.1% (41/65), and the misdiagnosis rate was 36.9% (24/65), among which 2 cases were misdiagnosed (intestinal duplication malformation combined with infection). In the negative group of 24 cases (24/65,36.9%), the length diameter of diverticulum measured during the operation was 3.24 \u0026plusmn; 1.61cm, and the tube diameter was 1.59\u0026plusmn;0.86cm.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.2.1 MD imaging findings\u003c/p\u003e\n\u003cp\u003e①\u0026nbsp;Anatomical location: the abdomen was evenly divided into 4 quadrants, and if the diverticulum was located above/below the umbilicus, it was denoted as the midline area. The positive cases were 82.9% (34/41) in the right quadrant (70.7% in the right lower quadrant and 12.2% in the right upper quadrant), 9.8% (4/41) in the midline region, and 3 cases (7.3%) in the left lower quadrant.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e②\u0026nbsp;Diverticulum size: The length diameter measured by MSCT (M/IRS = 2.50/1.36cm) was smaller than that measured during the operation (M/IRS = 3.00/3.00cm, p=0.003). There was no significant difference in diameter between them (M/IRS = 2.00/1.05cm vs 1.50/0.80cm) (P=0.24).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e③ Inflammatory changes(Figure 1): 31.7% (13/41) diverticulum wall thickness \u0026le;2 mm, 51.2% (21/41) 2-5 mm, 17.1% (7/41) \u0026ge;5 mm; 43.9% (18/41) with peripheral adipose space blurring.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e④\u0026nbsp;Diverticular contents: Gas accounted for 31.7% (13/41), fluid 48.8% (20/41), and fat density 14.6% (6/41) in positive cases.\u003c/p\u003e\n\u003cp\u003e⑤ Complication detection: The detection rate of MSCT was 22.0% (9/41) in positive group and 37.5% (9/24) in negative group. The detection rates of intussusception (14.6%, 6/41)(Figure 2) and intestinal obstruction (7.3%, 3/41) (Figure 3)in MSCT positive group were higher than those in negative group (8.3%, 2/24; 25.0%, 6/24), there was no significant difference (P =0.69, P =0.06).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.2.2 Analysis of misdiagnosis factors\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe diagnostic accuracy rate of MSCT was 63.1% (41/65), and the miss/misdiagnosis rate was 36.9% (24/65), among which 2 cases were misdiagnosed with intestinal duplication malformation and infection.\u003c/p\u003e\n\u003cp\u003eUnifactor analysis showed that six parameters were significantly correlated with the diagnostic coincidence rate (P \u0026lt; 0.05)(Table 2), including clinical dimension (anemia degree), image characteristics (intestinal wall thickness, content properties), and technical parameters (thin-layer reconstruction, multiplane recombination, and enhanced phase). Among them, enhanced phase sensitivity (92%) and specificity (95%) were the highest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Analysis of factors influencing the initial detection rate of MD in children by \u0026nbsp;MSCT(n=65)\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"957\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" rowspan=\"2\" valign=\"top\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 171px;\"\u003e\n \u003cp\u003eDetection rate(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003eSensitivity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eSpecificity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003eBoundary value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCut-off\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eAUC\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003eNone（n＝24）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eYes（\u003c/p\u003e\n \u003cp\u003en＝41）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" valign=\"top\" style=\"width: 150px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eClinical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eGender（male）\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e83.3%（20）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e75.6%（31）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.465\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eAge(years)\u003csup\u003e1%\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e8.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.701\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eAbdominal pain（+）\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e33.3%（8）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e24.4%（10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eAnaemia（+）\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e25%（6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e61%（25）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.031\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eDiverticulum length diameter\u003csup\u003e1\u003c/sup\u003e（cm）\u003csup\u003e%\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"10\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eImage features\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIntestinal wall\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026le;2mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e79.2%（19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e43.9%（18）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.017\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e＞2mm，\u0026le;5mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e12.5%（3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e43.9%（18）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e＞5mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e8.3%（2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e12.2%（5）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAround\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003ePoor filling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e41.7%（10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e42.5%（17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eBowel dilatation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e8.3%（2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e14.6%（6）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eCloudy fat space（+）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e50% (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e43.9%（18）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eContents\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e37.5%（9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e4.9%（2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.001\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp;\u0026nbsp;0.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eLiquid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e58.3%（14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e48.8%（20）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eGas\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e31.7%（13）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eFat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e4.2%（1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e14.6%（6）\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTechnique\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eThin layer（+）\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e25%（6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e51.2%（21）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.038\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 203px;\"\u003e\n \u003cp\u003eMRP（+）\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e25%（6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e51.2%（21）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.038\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eTime phase\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eArterial phase\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e65.8%（27）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 48px;\"\u003e\n \u003cp\u003e0.004\u003csup\u003e#\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 98px;\"\u003e\n \u003cp\u003e/\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote:1：Mann-Whitney U test；2：Chi-square test; #：p\u0026lt;0.05;%: interquartile\u003c/p\u003e"},{"header":"3. Discussion","content":"\u003cp\u003e3.1 Clinical features and diagnosis and treatment implications\u003c/p\u003e \u003cp\u003eThe male-to-female ratio in this pediatric MD cohort was 3.6:1, aligning with the known embryological predisposition of vitelline duct anomalies in males. Gastrointestinal bleeding (47.7%, 31/65) and abdominal pain (27.7%, 18/65) predominated as clinical presentations, with asymptomatic cases accounting for 24.6% (16/65)--a proportion markedly higher than the 4.2%-6.4% reported in adult populations\u003csup\u003e[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. This discrepancy may reflect pediatric-specific selection bias or heightened symptomatic severity in children.\u003c/p\u003e \u003cp\u003eNotably, the pain-dominant subgroup exhibited significantly higher complication rates than the bleeding-dominant subgroup (72.2%vs. 35.5%; P\u0026thinsp;=\u0026thinsp;0.001), alongside shorter symptom duration (median: 0.12 vs. 0.50 months). These findings suggest that abdominal pain-type MD may serve as an early indicator of secondary intestinal obstruction or volvulus, warranting prompt surgical evaluation. The underlying pathology appears multifactorial: 1) Mechanical obstruction: Narrow diverticular necks promote content stasis, bacterial overgrowth, and localized inflammation\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e; 2)Ectopic mucosa: Acid-secreting gastric tissue (identified in 85.7% of cases) elevates risks of ulceration and perforation\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. The ectopic tissue detection rate in this cohort was 64.6% (42/65), marginally lower than literature-reported 80%-85%\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. This gap likely stems from incomplete full-thickness histopathological sampling and oversight of microscopic ectopic foci\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOf particular note,93.5%(29/31)of bleeding-dominant cases presented with chronic anemia(hemoglobin:76.97\u0026thinsp;\u0026plusmn;\u0026thinsp;20.13g/L),necessitating transfusion in 96.7%(30/31). These data underscore MD\u0026rsquo;s role as a critical etiology of occult pediatric gastrointestinal bleeding.We advocate for routine inclusion of MD in differential diagnoses for pediatric anemia of unknown origin,particularly in preschool-aged males.\u003c/p\u003e \u003cp\u003e3.2 Strategies for improving MSCT diagnostic efficacy\u003c/p\u003e \u003cp\u003eThis study provides the first systematic evaluation of MSCT for pediatric MD, demonstrating a diagnostic accuracy of 63.1%--surpassing ultrasound but remaining inferior to technetium-99m scintigraphy\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. Among the 36.9% (24/65) of cases with missed/misdiagnosis, 62.5% (15/24) were asymptomatic and radiologically indistinguishable from normal bowel loops (79.2% showing\u0026thinsp;\u0026le;\u0026thinsp;2 mm intestinal wall thickness ). These findings led to the proposal of a diagnostic MSCT triad:①Right lower quadrant blind pouch (82.9%, 54/65); ②Arterial-phase mesenteric branch vascularity from the superior mesenteric artery; ③Peri-diverticular fat stranding (43.9%, 29/65).\u003c/p\u003e \u003cp\u003eCrucially, MSCT exhibited limitations in complication detection: while intussusception (14.6%, 9/65) and bowel obstruction (7.3%, 5/65) were identified in imaging-positive cases, 37.5% (9/24) of acute abdominal emergencies were missed in imaging-negative cohorts, primarily due to incomplete bowel assessment during urgent scans.\u003c/p\u003e \u003cp\u003eTo address these gaps, we propose an optimized protocol: 1)Anatomical tracing method: Retrograde tracing of the terminal ileum (60 cm from the ileocecal valve, covering MD-prone zones\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e) using thin-slice multiplanar reconstruction (\u0026le;\u0026thinsp;1 mm) to detect anti-mesenteric blind-end structures; 2) Phase selection: Prioritizing late arterial phase scans (sensitivity 92%, specificity 95%) to enhance visualization of MD-feeding vessels (persistent vitelline artery or ileocolic branches\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e) while reducing radiation exposure from dual-phase protocols.\u003c/p\u003e"},{"header":"4. Limitations","content":"\u003cp\u003eThis study has several limitations: First, its single-center retrospective design introduces potential selection bias. Second, the absence of a healthy control cohort restricts the ability to establish specificity thresholds. Additionally, non-uniform enhancement protocols (4.6% [3/65] undergoing non-contrast CT alone) may have influenced diagnostic accuracy. Future multi-center prospective trials with standardized imaging protocols should be conducted to validate the generalizability of the proposed MSCT diagnostic criteria and refine complication detection strategies.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003ePediatric MD exhibits symptom-driven clinical heterogeneity: abdominal pain-dominant subtypes warrant urgent evaluation for acute complications, whereas bleeding-dominant presentations necessitate assessment for chronic anemia. While MSCT diagnostic accuracy is constrained by anatomical visualization challenges, ​optimizing imaging protocols\u0026ndash;through the triad of right lower quadrant blind pouch morphology, peri-diverticular inflammation, and arterial-phase mesenteric vascularity, combined with thin-slice multiplanar reconstruction (\u0026le;\u0026thinsp;1 mm) and late arterial phase enhancement\u0026ndash;demonstrates potential to improve detection rates and guide differential diagnosis of acute abdomen while minimizing radiation exposure.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eConceptualization: Wenjing Huang，Huiying Wu Data curation: Wenjing Huang，Xiaorui Zhao Formal analysis: Xiaorui Zhao，Dongzhi He Funding acquisition: Huiying Wu Investigation: Xiaorui Zhao, Xiaozhu Huang Methodology: Wenjing Huang Project administration: Wenli Lai, Yue XI Resources: Xiaozhu Huang, Wenli Lai Software: Dongzhi He, Yue XI Supervision: Yue XI，Xiaorui Zhao Validation: Huiying Wu Visualization: Dongzhi He Writing-original draft: Wenjing Huang, Xiaorui Zhao Writing-review \u0026amp; editing:Huiying Wu\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSuh M, Lee HY, Jung K et al (2015) Diagnostic accuracy of meckel scan with initial hemoglobin level to detect symptomatic meckel diverticulum[J/OL]. Eur J Pediatr Surgery: Official J Austrian Association Pediatr Surg \u0026hellip; et Al] = Z Fur Kinderchirurgie 25(5):449\u0026ndash;453\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMalik AA, Shams-ul-Bari, Wani KA et al (2010) Meckel\u0026rsquo;s diverticulum-revisited[J/OL]. Saudi J Gastroenterology: Official J Saudi Gastroenterol Association 16(1):3\u0026ndash;7\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJj P, Bg W, Mk T et al (2005) Meckel diverticulum: the mayo clinic experience with 1476 patients (1950\u0026ndash;2002)[J/OL]. Ann Surg 241(3)[2025-02-12].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHansen CC, S\u0026oslash;reide K (2018) Systematic review of epidemiology, presentation, and management of Meckel\u0026rsquo;s diverticulum in the 21st century[J/OL]. Medicine 97(35):e12154\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark JJ, Wolff BG, Tollefson MK et al (2005) Meckel diverticulum: the Mayo Clinic experience with 1476 patients (1950\u0026ndash;2002)[J/OL]. Ann Surg 241(3):529\u0026ndash;533\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePlaton A, Gervaz P, Becker CD et al (2010) Computed tomography of complicated meckel\u0026rsquo;s diverticulum in adults: a pictorial review[J/OL]. Insights into Imaging 1(2):53\u0026ndash;61\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlson DE, Kim YW, Donnelly LF (2009) CT findings in children with meckel diverticulum[J/OL]. Pediatric Radiology. 39(7): 659\u0026ndash;663; quiz 766\u0026ndash;767\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eManner H, May A, Nachbar L et al (2006) Push-and-pull enteroscopy using the double-balloon technique (double-balloon enteroscopy) for the diagnosis of meckel\u0026rsquo;s diverticulum in adult patients with GI bleeding of obscure origin[J/OL]. Am J Gastroenterol 101(5):1152\u0026ndash;1154\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen JJ, Lee HC, Yeung CY et al (2014) Meckel\u0026rsquo;s diverticulum: factors associated with clinical manifestations[J/OL]. ISRN gastroenterology. 2014: 390869\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRattan KN, Singh J, Dalal P et al (2016) Meckel\u0026rsquo;s diverticulum in children: our 12-year experience[J/OL]. Afr J Pediatr surgery: AJPS 13(4):170\u0026ndash;174\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElsayes KM, Menias CO, Harvin HJ et al (2007) Imaging Manifestations of Meckel\u0026rsquo;s Diverticulum[J/OL]. Am J Roentgenol 189(1):81\u0026ndash;88\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Children, Meckel's diverticulum, CT, Diagnostic value","lastPublishedDoi":"10.21203/rs.3.rs-6721602/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6721602/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMeckel'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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 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\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 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.\u003c/p\u003e","manuscriptTitle":"The Application Value of MSCT in the Diagnosis of Meckel's Diverticulum in Children","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-18 09:18:49","doi":"10.21203/rs.3.rs-6721602/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"6cec0a40-d9cd-4ea9-a54c-99a37d852235","owner":[],"postedDate":"June 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-23T10:53:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-18 09:18:49","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6721602","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6721602","identity":"rs-6721602","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}