Assessing Gastric Meal Distribution and Accommodation Response During Gastric-Emptying Scintigraphy Using Physiologic Division of the Stomach at the Incisura.

Abstract

There is growing recognition of the importance of assessing intragastric meal distribution and gastric accommodation (GA) during gastric-emptying scintigraphy (GES) for patients with upper gastrointestinal symptoms. Methods for dividing the stomach have used arbitrary division into halves or thirds. Currently, there is no commercial software for analysis of intragastric meal distribution at 0 min (IMD0) of the post-meal-ingestion image to quantify GA. The goal of this study was to assess the ability to visually use the incisura as an anatomic and physiologic site to divide the proximal from the distal stomach and to establish reference values for IMD0. Methods: Healthy subjects (n = 53, 25 women and 28 men) with ages ranging from 19 to 66 y underwent 4-h GES using the currently recommended Society of Nuclear Medicine and Molecular Imaging GES egg-white solid-meal guideline. GA was quantitated using IMD0 (the ratio of proximal gastric counts to total gastric counts in the image immediately after meal ingestion, where the incisura was used to visually separate the proximal stomach [fundus and body] from the distal stomach [antrum]). Results: Agreement between nuclear medicine technologists' localization of the incisura with physician review was 92% (49/53 subjects). The mean IMD0 using the incisura was 0.867 ± 0.068 (SD). From the male and female data together, using 5%-95% quantiles as the best cutoffs, the lower and upper IMD0 limits were 0.74-0.96. There was no significant difference (Wilcoxon, P = 0.27) in IMD0 between men and women, at a median of 0.88 (interquartile range, 0.84-0.93) versus 0.87 (interquartile range, 0.83-0.90). Similarly, there was no significant difference (P = 0.67) in IMD0 between subjects 30 y or younger and subjects older than 30 y, at a median of 0.89 (interquartile range, 0.85-0.92) versus 0.87 (interquartile range, 0.82-0.90). Conclusion: Visual division of the stomach into proximal and distal components using the incisura allows for easy separation and quantification of the proximal from the distal stomach to assess IMD0 and GA. We established reference values for measurement of IMD0 during GES based on a physiologic separation of the proximal versus distal stomach defined by the incisura.