Comprehensive Radionuclide Esophagogastrointestinal Transit Study: Methodology, Reference Values, and Initial Clinical Experience

• Published in: Journal of Nuclear Medicine Vol. 56; no. 5; pp. 721 - 727
• Main Authors: Antoniou, Alexander J., Raja, Shreya, El-Khouli, Riham, Mena, Esther, Lodge, Martin A., Wahl, Richard L., Clarke, John O., Pasricha, Pankaj, Ziessman, Harvey A.
• Format: Journal Article
• Language: English
• Published: United States Society of Nuclear Medicine 01.05.2015
• Subjects: Adult; Aged; Diagnostic Techniques, Digestive System - standards; Esophagus - diagnostic imaging; Esophagus - physiology; Female; Gastric Emptying; Gastrointestinal diseases; Gastrointestinal Transit; Humans; Intestine, Large - diagnostic imaging; Intestine, Large - physiology; Intestine, Small - diagnostic imaging; Intestine, Small - physiology; Male; Middle Aged; Nuclear medicine; Radiology; Radionuclide Imaging; Reference Values; Technetium Tc 99m Pentetate; Young Adult; esophageal scintigraphy; gastric emptying; intestinal transit; gastrointestinal scintigraphy
• ISSN: 0161-5505; 1535-5667; 2159-662X; 1535-5667
• DOI: 10.2967/jnumed.114.152074

A radionuclide methodology and reference values have been developed for a single gastrointestinal transit study including esophageal transit, liquid and solid gastric emptying, and small- and large-bowel transit, using (111)In-diethylenetriaminepentaacetic acid (DTPA) with the standardized (99m)Tc-labeled solid meal. Eighteen healthy subjects and 18 patients were investigated. The esophageal transit study was performed with 3.7 MBq (0.1 mCi) of (111)In-DTPA in 15 mL of water. A liquid-only 30-min gastric-emptying study followed, with ingestion of 3.7 MBq (0.1 mCi) of (111)In-DTPA in 300 mL of water. Then, a simultaneous solid-liquid emptying study was acquired after ingestion of a solid (99m)Tc-sulfur colloid-labeled meal and 7.4 MBq (0.2 mCi) of (111)In-DTPA in 120 mL of water. Images were acquired intermittently for 4 h. Additional (111)In images were acquired at 5 and 6 h to measure small-bowel transit, and at 24, 48, and 72 h for large-bowel transit. Reference values were determined for esophageal transit (transit time, percentage emptying at 10 s), liquid-only gastric emptying (emptying half-time), liquid and solid emptying in a dual-phase solid-liquid study (emptying half-time and percentage emptying at 1, 2, 3, and 4 h), small-bowel transit index (percentage transit to ileocecal valve at 6 h), and colonic transit (geometric center and percentage colonic emptying) at 24, 48, and 72 h. Results from the first 18 patients found abnormal transit in 72% (13/18); clinical management changed in 61% (11/18). We have developed a radionuclide methodology and derived reference values for a comprehensive gastrointestinal transit study using (111)In-DTPA with the standardized (99m)Tc-labeled solid meal. Our initial clinical experience suggests clinical value.