TY - JOUR
T1 - Intragastric meal distribution during gastric emptying scintigraphy for assessment of fundic accommodation
T2 - Correlation with symptoms of gastroparesis
AU - NIH Gastroparesis Consortium
AU - Orthey, Perry
AU - Yu, Daohai
AU - Van Natta, Mark L.
AU - Ramsey, Frederick V.
AU - Diaz, Jesus R.
AU - Bennett, Paige A.
AU - Iagaru, Andrei H.
AU - Fragomeni, Roberto Salas
AU - McCallum, Richard W.
AU - Sarosiek, Irene
AU - Hasler, William L.
AU - Farrugia, Gianrico
AU - Grover, Madhusudan
AU - Koch, Kenneth L.
AU - Nguyen, Linda
AU - Snape, William J.
AU - Abell, Thomas L.
AU - Pasricha, Pankaj J.
AU - Tonascia, James
AU - Hamilton, Frank
AU - Parkman, Henry P.
AU - Maurer, Alan H.
N1 - Funding Information:
The Gastroparesis Clinical Research Consortium is supported by the National Institute of Diabetes and Digestive and Kidney Diseases (grants U01DK073975, U01DK073983, U01DK073985, U01DK074007, U01DK073974, and U01DK074008). No other potential conflict of interest relevant to this article was reported.
Funding Information:
This study was approved by the institutional review boards at Temple University School of Medicine and each of the NIH Gastroparesis Consortium centers contributing patients’ studies for analysis.
Publisher Copyright:
� Copyright 2018 SNMMI; all rights reserved.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Impaired fundic accommodation (FA) limits fundic relaxation and the ability to act as a reservoir for food. Assessing intragastric meal distribution (IMD) during gastric emptying scintigraphy (GES) allows for a simple measure of FA. The 3 goals of this study were to evaluate trained readers’ (nuclear medicine and radiology physicians) visual assessments of FA from solid-meal GES; develop software to quantify GES IMD; and correlate symptoms of gastroparesis with IMD and gastric emptying. Methods: After training to achieve a consensus interpretation of GES FA, 4 readers interpreted FA in 148 GES studies from normal volunteers and patients. Mixture distribution and k-agreement analyses were used to assess reader consistency and agreement of scoring of FA. Semiautomated software was used to quantify IMD (ratio of gastric counts in the proximal stomach to those in the total stomach) at 0, 1, 2, 3, and 4 h after ingestion of a meal. Receiver-operating-characteristic analysis was performed to optimize the diagnosis of abnormal IMD at 0 min (IMD0) with impaired FA. IMD0, GES, water load testing, and symptoms were then compared in 177 patients with symptoms of gastroparesis. Results: Reader pairwise weighted k-values for the visual assessment of FA averaged 0.43 (moderate agreement) for normal FA versus impaired FA. Readers achieved 84.0% consensus and 85.8% reproducibility in assessing impaired FA. IMD0 based on the division of the stomach into proximal and distal halves averaged 0.809 (SD, 0.083) for normal FA and 0.447 (SD, 0.132) (P, 0.01) for impaired FA. On the basis of receiver-operating-characteristic analysis, the optimal cutoff for IMD0 discrimination of normal FA from impaired FA was 0.568 (sensitivity, 86.7%; specificity, 91.7%). Of 177 patients with symptoms of gastroparesis, 129 (72.9%) had delayed gastric emptying; 25 (14.1%) had abnormal IMD0. Low IMD0 (impaired FA) was associated with increased early satiety (P 5 0.02). Conclusion: FA can be assessed visually during routine GES with moderate agreement and high reader consistency. Visual and quantitative assessments of FA during GES can yield additional information on gastric motility to help explain patients’ symptoms.
AB - Impaired fundic accommodation (FA) limits fundic relaxation and the ability to act as a reservoir for food. Assessing intragastric meal distribution (IMD) during gastric emptying scintigraphy (GES) allows for a simple measure of FA. The 3 goals of this study were to evaluate trained readers’ (nuclear medicine and radiology physicians) visual assessments of FA from solid-meal GES; develop software to quantify GES IMD; and correlate symptoms of gastroparesis with IMD and gastric emptying. Methods: After training to achieve a consensus interpretation of GES FA, 4 readers interpreted FA in 148 GES studies from normal volunteers and patients. Mixture distribution and k-agreement analyses were used to assess reader consistency and agreement of scoring of FA. Semiautomated software was used to quantify IMD (ratio of gastric counts in the proximal stomach to those in the total stomach) at 0, 1, 2, 3, and 4 h after ingestion of a meal. Receiver-operating-characteristic analysis was performed to optimize the diagnosis of abnormal IMD at 0 min (IMD0) with impaired FA. IMD0, GES, water load testing, and symptoms were then compared in 177 patients with symptoms of gastroparesis. Results: Reader pairwise weighted k-values for the visual assessment of FA averaged 0.43 (moderate agreement) for normal FA versus impaired FA. Readers achieved 84.0% consensus and 85.8% reproducibility in assessing impaired FA. IMD0 based on the division of the stomach into proximal and distal halves averaged 0.809 (SD, 0.083) for normal FA and 0.447 (SD, 0.132) (P, 0.01) for impaired FA. On the basis of receiver-operating-characteristic analysis, the optimal cutoff for IMD0 discrimination of normal FA from impaired FA was 0.568 (sensitivity, 86.7%; specificity, 91.7%). Of 177 patients with symptoms of gastroparesis, 129 (72.9%) had delayed gastric emptying; 25 (14.1%) had abnormal IMD0. Low IMD0 (impaired FA) was associated with increased early satiety (P 5 0.02). Conclusion: FA can be assessed visually during routine GES with moderate agreement and high reader consistency. Visual and quantitative assessments of FA during GES can yield additional information on gastric motility to help explain patients’ symptoms.
KW - Fundic accommodation
KW - Gastric emptying
KW - Gastroparesis
KW - Gastroparesis cardinal symptom index
KW - Patient assessment of upper gastrointestinal symptoms questionnaire
UR - http://www.scopus.com/inward/record.url?scp=85044784280&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044784280&partnerID=8YFLogxK
U2 - 10.2967/jnumed.117.197053
DO - 10.2967/jnumed.117.197053
M3 - Article
C2 - 28970332
AN - SCOPUS:85044784280
SN - 0161-5505
VL - 59
SP - 691
EP - 697
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 4
ER -