European Journal of Nuclear Medicine and Molecular Imaging Vol. 30, No. 12, December 2003 Abstract. Zenker’s diverticulum (ZD) is a rare patholo- gy, with a prevalence of between 0.01% and 0.11%. De- finitive diagnosis of ZD can be accomplished by contrast radiographic examination (barium oesophagogram, BE); oesophageal manometry (ME) is recommended mainly for those patients suffering from dysphagia and/or gas- tro-oesophageal reflux. The aims of the present study were to assess whether oropharyngo-oesophageal scin- tigraphy (OPES) is able (a) to visualise ZD and (2) to demonstrate the corresponding alteration in the swallow- ing phases. We studied 16 patients (nine male, seven fe- male, mean age 67.4 years), and 17 healthy volunteers (ten male, seven female, mean age 53 years) as a control group. All the patients underwent ME, BE and OPES. Nine patients underwent surgery and six of them were re-evaluated after 6 months. We administered 10 ml of water with 37 MBq of technetium-99m colloid through a straw, acquiring 480 sequential images (0.125 s/frame for a total of 60 s) with the patient standing in front of the gamma camera in the 80° right anterior oblique posi- tion. Two static images were performed at the end of the dynamic phase, before and after ingestion of 100 ml of unlabelled water to evaluate the presence of inflamma- tion (persistence of radioactivity in the diverticulum or oesophagus). Study of the sequential scintigraphic imag- es and time-activity curves permitted both qualitative (diverticulum visualisation, multiple deglutitions, reflux, presence of inflammation) and quantitative analyses [oral, pharyngeal and oesophageal transit times and re- tention indexes, tracheal aspiration percentage] of swal- lowing disorders. OPES showed a good correlation with the results of other diagnostic techniques usually per- formed in patients with this pathology, and especially with ME in the evaluation of oropharyngeal phase disor- ders. Furthermore, OPES is a sensitive and simple tech- nique that is well tolerated and entails a low irradiation dose for patients. Keywords: Zenker’s diverticulum – Oropharyngooesoph- ageal scintigraphy Eur J Nucl Med Mol Imaging (2003) 30:1657–1664 DOI 10.1007/s00259-003-1309-8 Introduction Zenker’s diverticulum (ZD) is a rare pathology of the digestive tract, with a reported prevalence of between 0.01% and 0.11%. The prevalence is higher in the elder- ly, with approximately 50% of cases occurring in the seventh and eighth decades; women are predominantly affected. Clinically, pharyngo-oesophageal diverticula present, in order of frequency, with upper oesophageal dyspha- gia, regurgitation of undigested food, aspiration, noisy deglutition, halitosis and changes in voice. The most po- tentially dangerous complications are aspiration and pneumonia (30% of patients), as well as perforation. Carcinoma is an unlikely complication (0.48% of cases). It is common to find associated gastrointestinal patholo- gy such as hiatal hernia, gastroduodenal ulcers, oesopha- geal spasm and achalasia [1]. Definitive diagnosis of ZD can be accomplished by contrast radiographic examination of the pharynx. Oesophageal manometry is recommended mainly for those patients suffering concomitantly from upper oesophageal dysphagia and gastro-oesophageal reflux. Many reports have demonstrated the utility of scintig- raphy in the evaluation of functional oesophageal pathol- ogy (such as achalasia and sclerodermia) and in differen- tiating normal from abnormal oesophageal function, but have failed to examine its ability to distinguish between motor and non-motor disorders of the oesophagus and more common anatomical disorders (such as benign and malignant lesions). Only in a few cases has the effective- Venanzio Valenza ( ✉ ) Institute of Nuclear Medicine, Policlinico A. Gemelli, Catholic University of Sacred Heart, Largo Gemelli 8, 00168 Rome, Italy e-mail: vvalenza@rm.unicatt.it Tel.: +39-06-30154978, Fax: +39-06-3058185 Original article Scintigraphic evaluation of Zenker’s diverticulum Venanzio Valenza 1 , Germano Perotti 1 , Daniela Di Giuda 1 , Gioacchino Castrucci 2 , Giuseppe Celi 3 , Gennaro Restaino 3 1 Institute of Nuclear Medicine, Policlinico A. Gemelli, Catholic University of Sacred Heart, Rome, Italy 2 Department of Surgery, Bel Colle Hospital, Viterbo, Italy 3 Institute of Radiology, Catholic University of Sacred Heart, Rome, Italy Received: 1 May 2003 / Accepted: 18 July 2003 / Published online: 9 September 2003 © Springer-Verlag 2003