Gastric accommodation measurements by single photon emission computed tomography and two-dimensional scintigraphy in diabetic patients with upper gastrointestinal symptoms

Abstract

Objective: To compare estimates of gastric accommodation (GA) with single photon emission computed tomography (SPECT) to measurements based on intragastric meal distribution immediately post-meal ingestion (IMD0 ).

Methods: We evaluated 108 diabetics with upper gastrointestinal (UGI) symptoms who had undergone gastric emptying of solids (GE) by scintigraphy and GA measurements by SPECT. Immediately after ingestion of a 99m Tc-labeled egg meal (time 0), we estimated IMD0 as radioactive counts or area of the proximal half of the stomach on two-dimensional images. Gastric volume (GV) during fasting and after 300 mL Ensure® was measured by SPECT to quantify accommodation volume (AV) or postprandial to fasting volume ratio (GVR). From the measured proximal gastric area, we estimated the volume of proximal stomach (4/3 × π × r3 ). We performed regression analyses to assess relationships between IMD0 and GA (AV) and GVR.

Results: There was a significant correlation between area and radioactivity counts in the proximal stomach (r = 0.67, P < 0.001); however, there was considerable interpersonal variation [bias 0.20 (95% CI -0.07, 0.47)]. There were no significant correlations between total GV or AV or VR by SPECT and measurements using IMD0 : proximal gastric counts, area, and estimated volume as continuous variables of dichotomized patient groups, based on published cutoff values. There were no significant differences in total gastric area or the IMD0 parameters (% area or % radioactive counts) between those with and without UGI symptoms except for fullness and satiety.

Conclusions: Intragastric meal distribution immediately post-meal ingestion is not significantly correlated with GA measurement by SPECT.

Keywords: dyspepsia; gastroparesis.

© 2019 John Wiley & Sons Ltd.

Figures

Figure 1.

Relationship between counts and area of proximal stomach at IMD0

Figure 2.

Bland-Altman graph comparing percent counts and calculated area of proximal stomach

Figure 3.. Relationship between total stomach area or proportion of proximal gastric area (relative to whole stomach area) based on 2-dimensional imaging and SPECT-measured gastric accommodation volume.

The correlation between total gastric area and gastric accommodation by SPECT was not statistically significant (r=0.12, p=0.217).

Figure 4.. Relationship between estimated proximal gastric volume based on 2-dimensional imaging and SPECT-measured gastric accommodation volume.

Note the weak, but statistically significant correlation based on spheroid or ellipsoid volume assumptions.