Intragastric meal distribution during gastric emptying scintigraphy for assessment of fundic accommodation: Correlation with symptoms of gastroparesis

NIH Gastroparesis Consortium

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)691-697
Number of pages7
JournalJournal of Nuclear Medicine
Volume59
Issue number4
DOIs
StatePublished - Apr 1 2018

Fingerprint

Gastroparesis
Gastric Emptying
Radionuclide Imaging
Meals
Stomach
Nuclear Medicine
ROC Curve
Software
Healthy Volunteers
Eating

Keywords

  • Fundic accommodation
  • Gastric emptying
  • Gastroparesis
  • Gastroparesis cardinal symptom index
  • Patient assessment of upper gastrointestinal symptoms questionnaire

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Intragastric meal distribution during gastric emptying scintigraphy for assessment of fundic accommodation : Correlation with symptoms of gastroparesis. / NIH Gastroparesis Consortium.

In: Journal of Nuclear Medicine, Vol. 59, No. 4, 01.04.2018, p. 691-697.

Research output: Contribution to journalArticle

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title = "Intragastric meal distribution during gastric emptying scintigraphy for assessment of fundic accommodation: Correlation with symptoms of gastroparesis",
abstract = "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.",
keywords = "Fundic accommodation, Gastric emptying, Gastroparesis, Gastroparesis cardinal symptom index, Patient assessment of upper gastrointestinal symptoms questionnaire",
author = "{NIH Gastroparesis Consortium} and Perry Orthey and Daohai Yu and {Van Natta}, {Mark L} and Ramsey, {Frederick V.} and Diaz, {Jesus R.} and Bennett, {Paige A.} and Iagaru, {Andrei H.} and Fragomeni, {Roberto Salas} and McCallum, {Richard W.} and Irene Sarosiek and Hasler, {William L.} and Gianrico Farrugia and Madhusudan Grover and Koch, {Kenneth L.} and Linda Nguyen and Snape, {William J.} and Abell, {Thomas L.} and Pasricha, {Pankaj Jay} and Tonascia, {James A} and Frank Hamilton and Parkman, {Henry P.} and Maurer, {Alan H.}",
year = "2018",
month = "4",
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doi = "10.2967/jnumed.117.197053",
language = "English (US)",
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pages = "691--697",
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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 Jay

AU - Tonascia, James A

AU - Hamilton, Frank

AU - Parkman, Henry P.

AU - Maurer, Alan H.

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

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