Abstract
Consensus protocol organizes gastric emptying scintigraphy (GES). There is low adherence to the protocol, and its applicability is reduced due to poor connection between retention and functional disorders. To optimize the consensus protocol, we added a dynamic acquisition and quantification of distinct parameters for healthy and dyspeptic subjects. Fourteen patients with functional dyspepsia (FD) and 20 healthy volunteers were undergone GES. The dynamic acquisition was added to the activity versus time curve composed of 4-time points (0, 60, 120, and 240 min) preconized. A dynamic set of 3060 images (1 Hz) were acquired between immediate and 60 min static images. Regions of interest were drawn to divide the stomach internally, and two gastric segmentations (similar areas and incisura) were adopted for all quantification of global GE and contractile parameters. Gastric retention at 4-time points preconized was not enough to identify differences between FD and healthy volunteers (R² = 0.99; p ˂ 0.0009). Retention percentage of test meal in the proximal stomach employing segmentation, T1/2, MGET and lag phase analysis were higher in dyspeptic compared to healthy volunteers. Impaired intragastric meal distribution was observed in FD by similar areas (p < 0.02) and incisura (p < 0.001). Reduction in the amplitude of contraction from the proximal region (p ˂ 0.015 and p ˂ 0.003) was observed in FD segmentation by similar areas and incisura, respectively. Impaired proximal stomach was observed in functional dyspepsia due to the insertion of dynamic acquisition proposed by consensus. Our approach can strengthen the consensus protocol and makes it capable of recognize and classify some diseases.
Highlights
Gastric emptying (GE) analysis is an important tool to assess gastric motility in clinical practice
Dyspeptic patients presented a longer lag phase for two methods of quantification: initial activity decreased by 10% (p < 0.05) and incisura segmentation (p < 0.03)
We found a larger delay time (p < 0.04) of GE in the functional dyspepsia (FD) when applied the segmentation by incisura (Table 1)
Summary
Gastric emptying (GE) analysis is an important tool to assess gastric motility in clinical practice. Several methods have been used for this purpose [1], including gastric emptying scintigraphy (GES), considered the gold standard technique. A consensus protocol was organized to define patient preparation, meal composition, acquisition protocols, and data processing [2, 3]. The guideline consensus represents an essential tool to GES standardization, providing conditions to normalize reference patterns and compare nuclear medicine laboratory results. The guideline consensus recommended static image acquisition at least the four time points: immediately and at 60, 120, and 240 minutes after meal ingestion. GE analysis is still calculated by gastric emptying half-time (T_(1⁄2)) in detriment to gastric meal retention [3] and the selection of time points for GE studies by scintigraphy is controversial [4,5,6,7]. The lag time was not standardized to the meal proposed, either its measurement methods
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