Recent Advances in GI Nuclear Medicine-Updated 05-28-10 PDF

RecentadvancesinGINuclearMedicine
KellyAnneHolesLewis,MD
GICounciloftheSocietyofNuclearMedicine
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NeurogastroenterolMotil.2009Dec21.[Epubaheadofprint]
Lowerfunctionalgastrointestinaldisorders:evidenceofabnormalcolonic
transitina287patientcohort.
ManabeN,WongBS,CamilleriM,BurtonD,McKinzieS,ZinsmeisterAR.
ClinicalEntericNeuroscienceTranslationalandEpidemiologicalResearch(CENTER),MayoClinic,Rochester,
MN,USA.
AbstractBackgroundAbnormalitiesofcolonicmotilitywerereportedinrelativelysmallstudiesofpatientswith
lowerfunctionalgastrointestinaldisorders(FGID)includingirritablebowelsyndrome(IBS).Theinfluenceof
genderandbodymassontheobservedmotorpathophysiologyisunclear.Wesoughttocomparecolonictransit
inpatientswithindifferentlowerFGIDsubgroupsandhealthycontrols,controllingforgenderandBMI,andto
determinewhetherBMIindependentlyinfluencescolonicmotility.MethodsWeevaluatedascintigraphic
gastrointestinalandcolonictransitdatabaseof287lowerFGIDpatientsassociatedwithconstipation(IBSC,or
functionalconstipation,n=118),diarrhoea(IBSDorfunctionaldiarrhoea,n=139)ormixedbowelfunction
(IBSM,n=30)and170healthycontrols.Wemeasuredcolonfillingat6h(CF6h),andoverallcolonictransitat
8,24and48h.KeyResultsColonfillingat6hdidnotdifferentiatehealthfromFGID.Colonictransitwas
abnormalat24h(GC24of<1.50or>3.86)in29.7%ofalllowerFGIDpatients.Therewasasignificantoverall
associationbetweencolonictransitandsubjectgroup(healthycontrolsandFGIDsubgroups)at8(P=0.01),24
(P<0.001)and48h(P<0.001)inparticularforthosewithdiarrhoeaorconstipationat24and48h(P<0.05),
evenafteradjustingforage,genderandBMI.Inaddition,BMIwasassociatedwithcolonictransitafteradjusting
forage,genderandsubjectgroup.Conclusions&InferencesAbnormaltransitisdocumentednoninvasively
withscintigraphyin30%oflowerFGIDpatients;transitmeasurementmayhelpdocumentpathophysiologyand
informselectionoftherapyinlowerFGID.
PMID:20025692[PubMedassuppliedbypublisher]
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NuclMedCommun.2009Dec;30(12):93444.
Developmentandintrainstitutionalandinterinstitutional
validationofacomprehensivenewhepatobiliarysoftware:Part1
Liverandgallbladderfunction.
KrishnamurthyGT,KrishnamurthyS,GambhirSS,RodriguesC,RosenbergJ,SchiepersC,BuxtonThomasM.
DepartmentofNuclearMedicine,TualityCommunityHospital,Hillsboro,Oregon97123,USA.
GTKrishna@aol.com
OBJECTIVE:Todevelopasoftwaretoolforquantificationofliverandgallbladderfunction,andtoassessthe
repeatabilityandreproducibilityofmeasurementsmadewithit.MATERIALSANDMETHODS:Thesoftwaretool
developedwiththeJAVAprogramminglanguageusestheJAVA2StandardEditionframework.Aftermanual
selectionoftheregionsofinterestona99mTchepaticiminodiaceticacidstudy,theprogramcalculates
differentialhepaticbileflow,basalduodenogastricbilereflux(BDGBR),hepaticextractionfraction(HEF)of
boththelobeswithdeconvolutionalanalysisandexcretionhalftimewithnonlinearleastsquaresfit.
Gallbladderejectionfraction,ejectionperiod(EP),ejectionrate(ER),andpostcholecystokinin(CCK)DGBRare
calculatedafterstimulationwithCCK8.Toassessintraobserverrepeatabilityandintraobserver
reproducibility,measurementsfrom10normalparticipantswereanalyzedtwicebythreenuclearmedicine
technologistsattheprimarycenter.Toassessintersitereproducibility,measurementsfromasupersetof24
normalparticipantswerealsoassessedoncebythreeobserversattheprimarycenterandsingleobserverat
threeothersites.RESULTS:Forthe24controlparticipants,mean+/SDofhepaticbileflowintogallbladderwas
63.87+/28.7%,HEFoftherightlobe100+/0%,leftlobe99.43+2.63%,excretionhalftimeoftherightlobe
21.50+6.98min,leftlobe28.3+/11.3min.BasalDGBRwas1.2+/1.0%.Gallbladderejectionfractionwas80+/
11%,EP15.0+/3.0min,ER5.8+/1.6%/min,andDGBRCCK1.3+/2.3%.LeftandrightlobeHEFwasvirtually
identicalacrossreaders.Allmeasuresshowedhighrepeatabilityexceptforgallbladderbileflow,basalDGBR,
andEP,whichexhibitedmarginalrepeatability.Ejectionfractionexhibitedhighreproducibility.Therewashigh
concordanceamongthethreeprimarycenterobserversexceptforbasalDGBR,EP,andER.Concordance
betweentheprimarysiteandoneoftheothersiteswashigh,onewasfair,andonewaspoor.CONCLUSION:New
UnitedStatesFoodandDrugAdministrationapprovedpersonalcomputerbasedKrishnamurthyHepatoBiliary
Softwareforquantificationoftheliverandgallbladderfunctionshowspromiseforconsistentlyrepeatableand
reproducibleresultsbothwithinandbetweeninstitutions,andmayhelptopromoteuniversalstandardization
ofdataacquisitionandanalysisinnuclearhepatology.
PMID: 19858769 [PubMed - indexed for MEDLINE]
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Hepatogastroenterology.2009JulAug;56(93):10538.
Detectionofgastrointestinalandabdominalinfectionsby99mTc
antigranulocyteantibodies.
ArtikoV,PetroviM,SobiSaranoviD,KrajnoviJaksiE,TuliC,MilovanoviJ,DjukiV,RankoviV,MatiS,
AntiA,RadomanI,LauseviZ,StojkoviM,PavloviS,ObradoviV.
InstituteforNuclearMedicine,ClinicalCenterofSerbia,Visegradska26,11000Beograd,Serbia.
veraart@beotel.yu
BACKGROUND/AIMS:Theaimofthestudywasdetectionofabdominalinfectionsby99mTcantigranulocyte
antibodies.METHODOLOGY:Totalof36patientswithclinicalsuspiciononabdominalorgastrointestinal
infectionswasinvestigated.RESULTS:Therewere23truepositive(TP)findings(onepulmonaryabscess,2
subhepaticabscessesaftersurgery,2perianalfistula,2chronicand4acuteappendicitis,5abdominaland3
pelvicabscesses,3M.Crohn,oneulcerativecolitis),9truenegative(TN)(3tumorsofthecoecum,2tumorsof
papillaWateri,2gastriccarcinoma,2coloncarcinoma),and4falsenegative(FN)(2abscessessubphrenicand2
enterocolicfistula).Falsepositive(FP)findingswerenotobserved.Thesmallestlesionfoundwas19x18mm.
SPECTincreasedthenumberofTPfindingsfrom17to23.Fifteenof23infectiousofinflammatorylesionscould
bedetectedintheearlyscan.Sensitivitywas85%,specificity100%,positivepredictivevalue100%,negative
predictivevalue69%andaccuracy89%.CONCLUSION:Accordingtothepresentresults,scintigraphywith
99mTcantigranulocyteantibodiesisausefulmethodfordetectionandassessmentofexactlocalization
abdominalinfections,whichisveryimportantforthepromptandappropriatetherapy.
PMID:19760940[PubMedindexedforMEDLINE]
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JNuclMedTechnol.2009Sep;37(3):196200.Epub2009Aug19.
Procedureguidelineforadultsolidmealgastricemptyingstudy3.0.
DonohoeKJ,MaurerAH,ZiessmanHA,UrbainJL,RoyalHD,MartinCominJ;SocietyforNuclearMedicine;
AmericanNeurogastroenterologyandMotilitySociety.
BethIsraelDeaconessMedicalCenter,Boston,Massachusetts,USA.kdonohoe@caregroup.harvard.edu
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JClinGastroenterol.2009Aug;43(7):63943.
Liquidgastricemptyingisoftenabnormalwhensolidemptyingisnormal.
ZiessmanHA,OkoloPI,MullinGE,ChanderA.
DivisionofNuclearMedicine,RussellH.MorganDepartmentofRadiologyandRadiologicalSciences,Johns
HopkinsMedicalInstitutions,Baltimore,MD,USA.hziessm1@jhmi.edu
BACKGROUND:Themedicalliteraturestatesthatsolidradionuclidegastricemptyingstudiesaremoresensitive
thanliquidstudiesfordetectionofgastroparesisandthusliquidstudiesarerarelyindicated.Atourinstitution,
patientsareoftenreferredforbothstudies.Ourinitialpurposewastoreviewtheresultsinthosepatients.The
surprisingresultsledustoinitiateaprospectiveinvestigationtomoredirectlydeterminetherelativevalueof
solidversusliquidemptyingstudies.METHODS:Theretrospectivereviewincluded21patientswhohadboth
studiesperformedonseparatedays.Thesubsequentprospectiveinvestigationwasinitiatedsothatthesolid
andliquidemptyingstudieswereacquiredsequentiallyonthesameday.Atotalof40consecutivepatientswith
symptomssuggestiveofgastroparesis(meanage44.8,12males,28females)wereinvestigated.Allingested300
mLwaterwithradiotracerandwereimagedeachminute30.Theytheningestedtheradiolabeledsolidmealand
wereimagedeachhour4.Aliquidemptyingrate(T1/2)andsolidpercentemptyingeachhour4was
determined.RESULTS:Intheretrospectivereview,17of21patientshadnormalsolidemptying;ofthose,13had
delayedliquidemptying.Inthesubsequentprospectivestudy,30/40(75%)hadnormalsolidemptying;of
those,10(33%)haddelayedliquidemptying.Ninepatients(23%)haddelayedsolidemptying;13(32%)had
delayedliquidemptying.CONCLUSIONS:Liquidgastricemptyingiscommonlyabnormalinpatientswhohave
normalsolidstudies.Liquidstudiesshouldberoutinelyperformedinadditiontosolidstudiestofullyevaluate
gastricmotilityinpatientswithsymptomssuggestiveofgastroparesis.
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WorldJGastroenterol.2009Jun14;15(22):2693700.
Roleofscintigraphyininflammatoryboweldisease.
StathakiMI,KoukourakiSI,KarkavitsasNS,KoutroubakisIE.
Thediagnosisofinflammatoryboweldisease(IBD)dependsondirectendoscopicvisualizationofthecolonic
andilealmucosaandthehistologicalstudyoftheobtainedsamples.Radiologicalandscintigraphicmethodsare
mainlyusedasanadjuncttoendoscopy.Inthisreview,wefocusonthediagnosticpotentialofnuclearmedicine
procedures.Thevalueofallradiotracersisdescribedwithspecialreferencetothosewithgreaterexperience
andmoresatisfactoryresults.Tc99mhexamethylpropyleneamineoximewhitebloodcellsremainawidely
acceptablescintigraphicmethodforthediagnosisofIBD,aswellasfortheevaluationofdiseaseextensionand
severity.Recently,pentavalentTc99mdimercaptosuccinicacidhasbeenrecommendedasanaccuratevariant
andacomplementarytechniquetoendoscopyforthefollowupandassessmentofdiseaseactivity.Positron
emissiontomographyaloneorwithcomputedtomographyusingfluorine18fluorodeoxyglucoseappearstobe
apromisingmethodofmeasuringinflammationinIBDpatients.
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AnnNuclMed.2009Feb;23(2):97105.Epub2009Feb19.
Detectionofectopicgastricmucosausing99mTcpertechnetate:reviewof
theliterature.
KiratliPO,AksoyT,BozkurtMF,OrhanD.
DepartmentofNuclearMedicine,HacettepeUniversity,MedicalFaculty,06100Sihhiye,Ankara,Turkey.
pkiratli@hacettepe.edu.tr
Technetium99m((99m)Tc)pertechnetatescintigraphyinachildwithacutegastrointestinalbleedingof
unknownoriginsuggestsectopicgastricmucosacausedbyMeckel'sdiverticulumorgastrointestinalduplication
cysts.Ourobjectivewastodefinethepatternsofscintigraphicfindingslikelytobeencounteredinpatientswith
ectopicgastricmucosawithillustrativecasesandtoreviewtheliterature.Fiftychildren(age1yearto14years)
wereevaluatedforectopicgastricmucosausing(99m)Tcpertechnetatescintigraphy.Functioningectopic
gastricmucosawasdetectedineightpatientswithMeckel'sdiverticulaandthreepatientswithbowel
duplication.Threepatientsshowedatypicalfindingsonscintigraphywhichwereperforatedappendix,calyceal
stasis,andregionalenteritis.EctopicfunctioninggastricmucosainMeckel'sdiverticulumisvisualized
simultaneouslywiththestomach,whereasinintestinalduplicationstraceractivitycanbevisualizedinthe
dynamicsequenceorbeforegastrictracervisualizationinanirregularpattern.Avarietyofscintigraphic
patternscanbefoundinpatientswithectopicgastricmucosaundergoing(99m)Tcpertechnetatescintigraphy
dependingonthelocationandsizeoftheectopictissue.Also,acquisitionofdelayedimagesisusefulwhenthe
initialimagesareequivocalinchildren.
PMID: 19225931 [PubMed - indexed for MEDLINE]
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ClinNuclMed.2008Dec;33(12):8613.
Intestinalmalrotationinadultseenonhepatobiliaryscintigraphy.
BajajS,FinkBennettD,BloomDA.
DepartmentofNuclearMedicine,WilliamBeaumontHospital,RoyalOak,Michigan48073,USA.
Hepatobiliaryscintigraphyisprimarilyusedtodiagnoseacuteandchronicbiliarytractdisorders.However,its
potentialroleindiagnosingunsuspectedextrahepaticpathologyisnotwelldescribed.Wepresent2adult
patientswithchronicabdominalpainwhounderwenthepatobiliaryscintigraphyforevaluationofcysticduct
patency.Inbothcases,theproximalsmallbowelwaslocatedontherightsideoftheabdomen,whichsuggested
thediagnosisofmalrotation.RetrospectivereviewofabdominalCTscan,uppergastrointestinalseries,and
subsequentlaparotomyconfirmedmalrotation.Thediagnosisofmalrotationinboththesepatientswasfirst
suggestedonhepatobiliaryscintigraphy,whichsignificantlyimpactedtheirsubsequentmanagement.
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SeminNuclMed.2009Mar;39(2):12445.
Functionalimagingofinflammatorydiseasesusingnuclearmedicine
techniques.
BasuS,ZhuangH,TorigianDA,RosenbaumJ,ChenW,AlaviA.
RadiationMedicineCenter(BARC),TataMemorialHospitalAnnex,Mumbai,India.
Molecularimagingwithpositronemissiontomography(PET)andsinglephotonemissioncomputed
tomography(SPECT)isincreasinglyusedtodiagnose,characterize,andmonitordiseaseactivityinthesettingof
inflammatorydisordersofknownandunknownetiology.Thesedisordersincludesarcoidosis,atherosclerosis,
vasculitis,inflammatoryboweldisease(IBD),rheumatoidarthritis(RA),anddegenerativejointdisease.Gallium
67((67)Ga)citrate,labeledleukocyteswithtechnetium99m((99m)Tc)orindium111((111)In),and(18)F
fluorodeoxyglucose(FDG)representthemostwidelyusedradiopharmaceuticalagents.However,other
preparations,suchaslabeledmurinemonoclonalantigranulocyteantibodiesandlabeledhumanpolyclonal
nonspecificimmunoglobulinG,chemotacticpeptides,interleukins,chemokines,andliposomes,havebeenused
toimageinflammation.Also,(99m)Tcnanocolloidscintigraphyhasbeenfoundtobesuitableforboneandjoint
diseases,especiallyRA.Amongthesinglephotonemittingimagingagents,therecommendedradiotracerfor
abdominalinflammationhasbeen(99m)Tchexamethylpropyleneamineoxime(HMPAO)labeledleukocytes.
Duringthelastseveralyears,FDGPETimaginghasbeenshowntohavegreatvalueforthedetectionof
inflammationandhasbecomethecenterpieceofsuchinitiatives.Thisverypowerfultechniquewillplayan
increasinglyimportantroleinthemanagementofpatientswithinflammatoryconditions.FDGPETcanprovide
valuableinformationinpatientswithpulmonaryandextrapulmonarysarcoidosis,andisausefultoolfortesting
theefficacyofvarioustreatments.FDGPETcombinedwithcomputedtomographyholdsgreatpromisefor
assessingatherosclerosisofthelargearteries.Thismodalityisverysensitiveindetectinglargevesselvasculitis
andcanbeusedtomonitorthediseasecourse.FDGPETisalsobeingusedtostudytheinflamedsynovialjoints
bothintheexperimentalandclinicalsettings,especiallyfortheinvestigationandmanagementofRAand
degenerativejointdisease.Thistechniquealsohasthepotentialtobecometheimagingmodalityofchoicein
assessingIBD,replacingradiolabeledautologousleukocyteimaginginthissetting.Detectionofinflammationin
thelungsandairwaysmayimproveourknowledgeaboutamultitudeofdisordersthataffectthesestructures.
Therefore,functionalimaging,ledbyFDGPETimaging,islikelytoplayanincreasinglycriticalroleinassessing
inflammatorydisordersofknownandunknownetiologies,andwillimprovetheirmanagementimmenselyin
thefuture.
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CasesJ.2009Dec10;2:9300.
Hepatobiliaryscintigraphyinvasculitisofthegallbladderasa
manifestationofpolyarteritisnodosa:acasereport.
KitzingB,O'TooleS,WaughA,ClaytonJ,McGillN,AllmanKC.
DepartmentofPETandNuclearMedicine,RoyalPrinceAlfredHospital,MissendenRoad,Sydney,NewSouth
Wales,Australia.
INTRODUCTION:Polyarteritisnodosacanonrareoccasionsmanifestitselfasvasculitisofthegallbladder.
Patientstypicallypresentwithrightupperquadrantpainandareinitiallyworkedupforcholecystitis.The
definitivediagnosisisthenusuallybasedonsurgicalandhistopathologicalfindings.CASEPRESENTATION:In
thiscasea23yearoldCaucasianfemalepresentedwitha3weekhistoryofrightupperquadrantpainand
fevers.CONCLUSION:Theclinicalpathwayandimagingfindingsofararecaseofgallbladdervasculitisasa
manifestationofpolyarteritisnodosaaredemonstrated.
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NuclMedCommun.2009Sep;30(9):66974.
Diagnosticvalueofgallbladderemptyingvariablesinchronicacalculous
cholecystitisasassessedbyfattymealcholescintigraphy.
AlMuqbelKM.
DepartmentofRadiologyandNuclearMedicine,SchoolofMedicine,JordanUniversityofScienceand
Technology,Irbid22110,Jordan.kusai10@hotmail.com
OBJECTIVE:Themainpurposeofthisstudywastodeterminethediagnosticvalueofgallbladderemptying
variablesinchronicacalculouscholecystitis(CAC).Thevariablesinvestigatedwerelatentperiod,gallbladder
ejectionfraction(GBEF)andpatternsofgallbladderemptying.Inaddition,twootherbiliarysystemmotility
variableswereinvestigatedincludingtheonsetofgallbladderfillingandbiliarytoboweltransittime.
METHODS:Thirtyninehealthyvolunteersunderwentfattymealcholescintigraphy(CS)prospectivelyto
determinethenormalvaluesofthesevariables.Retrospectively,fattymealCSstudiesof88patientssuspected
ofhavingCACwereretrievedandreprocessedtoobtaincorrespondingvaluesofthesevariables,whichthen
comparedwithnormalvalues.RESULTS:Themeanonsetofgallbladderfillingforpatientgroupswasnot
significantlydifferentfromvolunteergroupmean.Themean+/SDGBEFvalueforCACgroup(29+/20%)was
significantlylowerthanvolunteergroupvalue(54+/23%),whereasfornonCACgroup(60+/21%)itwasnot
significantlydifferent.ThelatentperiodwasfoundinvariableandnotsignificantinCACdiagnosis.Twopatterns
ofgallbladderemptyingwerenoted:endedandcontinuous.Thepatternofgallbladderemptyingdidnotaffect
themeanGBEFandwasfoundinsignificantinthediagnosisofCAC.Therewasnosignificantdifferenceinthe
numberofcaseswithlatebiliarytoboweltransittimebetweenthegroups.CONCLUSION:Thesinglemost
importantgallbladderemptyingvariableindiagnosingCACistheGBEF.Thelatentperiodandthepatternof
gallbladderemptyingaswellastheonsetofgallbladderfillingandbiliarytoboweltransittimeareofno
significantdiagnosticvalueinCAC.
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SeminNuclMed.2009May;39(3):17485.
Interventionsusedwithcholescintigraphyforthediagnosisof
hepatobiliarydisease.
ZiessmanHA.
DivisionofNuclearMedicine,RussellH.MorganDepartmentofRadiologyandRadiologicScience,JohnsHopkins
MedicalInstitutions,Baltimore,MD212780817,USA.hziessm1@jhmi.edu
Sincetheearly1980sinterventionshavebeenusedinconjunctionwith(99m)Tciminodiaceticacid(IDA)
radiopharmaceuticalsinmanydifferentclinicalsituations,eg,topreparethepatientforthestudy,toreducethe
timeofastudy,toimproveitsdiagnosticaccuracy,andtomakediagnosesnototherwisepossible.Interventions
allhaveunderlyingphysiologicalrationales.Someoftheseinterventionsareassimpleashavingthepatientfast
beforethestudyoreatamealwithhighfatcontent.However,mostarepharmacologicinterventions,eg,
morphinesulfate,cholecystokinin,andphenobarbital.Althoughtheseareprobablythemostcommon
interventionsusedtoday,numerousotherinterventionshavebeenusedduringtheyearsandlikelywillbein
thefuture.Interventionshaveaidedinthediagnosisofacutecholecystitis,chroniccholecystitis,biliary
obstruction,andsphincterofOddidysfunction.Thisreviewwilldiscussindetailtheinterventionscommonlyis
usetodayandinsomewhatlessdetailmanythathavebeensuccessfullyusedonaninvestigationalbasisand
mayhavesomelargerroleinthefuture.
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Usefulnessoffattymealstimulatedcholescintigraphyinthediagnosisand
treatmentofchronicacalculouscholecystitis.
AlMuqbelK,BaniHaniM,DaradkehM,RashdanA.
DepartmentofRadiologyandNuclearMedicine,SchoolofMedicine,JordanUniversityofScienceand
Technology,POBox3030,Irbid22110,Jordan.kusai10@hotmail.com
OBJECTIVE:Fattymealcholescintigraphy(fattymealCS)isapotentialphysiologicalternativefor
cholecystokinin(CCK)CSinthediagnosisandtreatmentofchronicacalculouscholecystitis(CAC).However,
therearelimiteddataintheliteraturetosupportthisassumption.Ourobjectivewastodeterminethe
usefulnessoffattymealCSinthediagnosisandtreatmentofCAC.METHODS:Weretrospectivelyreviewedthe
medicalrecordsof198patientswhohadundergonefattymealCSforpresumedCAC.Dataretrievedfocusedon
symptomimprovementfollowingmanagement.Gallbladderejectionfraction(GBEF)of50%orlesswas
consideredabnormal.Patientsweredividedintogroupsonthebasisoftestresultsandmanagement.RESULTS:
Ingroup1a,patientswithlowGBEFandcholecystectomy,88%(54of61)reportedsymptomimprovement,
whereastheremaining12%(7of61)retainedtheirsymptoms.Group1bconsistedofpatientswithlowGBEF
andwhoweremanagedmedically.Persistenceofsymptomswasnotedin76%(32of42)ofpatients,whereas
theremaining24%(10of42)hadsymptomimprovement.Group2consistedofpatientswithnormalGBEF.
Followupshowedthat60%(47of78)ofpatientshadsymptomimprovementeitherspontaneouslyoron
medicaltreatment,whereastheremaining40%(31of78)retainedtheirsymptoms.CONCLUSIONS:Fattymeal
CSisaveryusefultechniqueinthediagnosisofCAC.ItpredictsagoodsurgicaloutcomeonceGBEFislowin
patientswithhighpretestprobabilityforCAC.Moreover,fattymealCSmaybeagoodalternativetoCCKCS.
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NuclMedCommun.2010Jan12.[Epubaheadofprint]
Utilityofwholeguttransitscintigraphyinpatientswithchronic
gastrointestinalsymptoms.
BalanK,AlwisL,SonodaLI,PawarooD,ParryJonesDR,MiddletonS.
DepartmentsofNuclearMedicineandGastroenterology,Addenbrooke'sHospital,Cambridge,UK.
BACKGROUND:Toreviewourexperienceofdoingwholeguttransitscintigraphyinpatientspresentingwith
functionalgastrointestinalproblemsandtodetermineitsclinicalusefulness.METHOD:Allwholeguttransit
studiesusingaliquidmealovera5yearperiodwerereviewedandclinicaloutcomeassessed.RESULTS:Fifty
fivepatients(44women;meanage43years)underwentwholeguttransitscintigraphyusingindium111
diethylenetriaminepentaaceticacidinwater.Themainsymptomswereconstipation(49%),dyspepsia(25%)
anddiarrhoea(25%).Colonictransitwasdelayedin63%ofpatientswithconstipation,whichwassignificantly
(P=0.005)higherthanthatinpatientswithdyspepsia.Delayedcolonictransitwasalsoseenin43%ofpatients
withdiarrhoea.Only26%ofpatientswithconstipationhadadelayinliquidgastricemptyingandsmallbowel
transit.Gastricemptying,smallboweltransitandcolonictransitwerenormalin43,79and29%ofpatientswith
dyspepsia,respectively.Therewasnostaticallysignificantdifferenceingastricemptyingandsmallbowel
transitbetweenpatientswithconstipation,diarrhoeaanddyspepsia.CONCLUSION:Liquidphasewholegut
transitscintigraphyseemstobeausefulinvestigationinpatientswithchronicgastrointestinalsymptoms.
Rationaluseofthismodalitymayhelptheclinicianchangethemanagementorbettercharacterizethe
underlyingproblem/diagnosisinthemajorityofpatientswithfunctionalsymptoms.
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AnnNuclMed.2009Nov;23(9):7716.Epub2009Oct24.
Esophagealtransitscintigraphyandstructuredquestionnaireinpatients
withsystemicsclerosiswithendoscopicallyprovenrefluxesophagitis.
NakajimaK,InakiA,HiramatsuT,HasegawaM,FujimotoM,TakeharaK,KinuyaS.
DepartmentofNuclearMedicine,KanazawaUniversityHospital,Kanazawa,Japan.nakajima@med.kanazawa
u.ac.jp
OBJECTIVES:Esophagealcomplicationsarecommoninpatientswithsystemicsclerosis(SSc).Therelationship
betweengastroesophagealreflux(GER)symptomsanddysmotilitywasexaminedinendoscopicallyconfirmed
patientssuspectedofhavingrefluxesophagitis.METHODS:Atotalof32patientswithlimitedanddiffusetype
SSc(lSSc,dSSc)wereexaminedbasedonastructuredquestionnairescore(QS)ofGERsymptoms,retention
fractionofesophagealscintigraphyat90s(R(90))andgastricemptyingtime.RESULTS:TheQSwas
significantlyhigherintherefluxesophagitisgroupthaninthenonesophagitisgroup(5.4+/3.5,1.4+/2.9,P=
0.003).WhenthenonesophagitisgroupwasfurtherdividedintolSScanddSScgroups,R(90)washigherinthe
refluxesophagitisgroup(31+/18%)andthenonesophagitisgroupwithdSSc(34+/32%)thaninthenon
esophagitisgroupwithlSSc(8+/3%,P=0.02).BothhighR(90)>or=15%andQS>or=4indicatedreflux
esophagitis.Conversely,bothnormalR(90)andQSindicatednorefluxesophagitis.CONCLUSION:Acombination
ofesophagealscintigraphyandstructuredquestionnairedemonstrateddifferentaspectsofesophageal
dysfunction,namelydysmotilityandGER.PatientswithhighQSanddysmotilitymaybeindicatedforfurther
evaluationincludingendoscopicexaminationandmedicaltreatment.
PMID:19851822[PubMedinprocess]
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JNuclMedTechnol.2009Sep;37(3):196200.Epub2009Aug19.
Procedureguidelineforadultsolidmealgastricemptyingstudy3.0.
DonohoeKJ,MaurerAH,ZiessmanHA,UrbainJL,RoyalHD,MartinCominJ;SocietyforNuclearMedicine;
AmericanNeurogastroenterologyandMotilitySociety.
BethIsraelDeaconessMedicalCenter,Boston,Massachusetts,USA.kdonohoe@caregroup.harvard.edu
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ObesSurg.2009Sep;19(9):12703.Epub2009Jun5.
Gastricemptyingofsemisolidsandpouchmotilityfollowinglaparoscopic
adjustablegastricbanding.
TiktinskyE,LantsbergL,LantsbergS,MizrahiS,AgranotvichS,FrigerM,KirshteinB.
DepartmentsofNuclearMedicine,SorokaUniversityMedicalCenter,BeerSheva,Israel.
BACKGROUND:Laparoscopicadjustablegastricbanding(LAGB)hasbeenpopularizedasaneffective,safe,
minimallyinvasivesurgicaltechniqueforthetreatmentofmorbidobesity.Weperformedapilotstudyto
evaluategastricemptyingofsemisolidmealsandantralmotilityfollowingLAGB.METHODS:Gastricemptying
halftimewascomparedinnormalvolunteersandmorbidlyobesepatientsbeforeand612monthsafterLAGB
usingsulfurcolloidlabeledsemisolidmeals.RESULTS:Therewasnodifferenceinmeanagebetweengroups.
Womenwereprevalentinthegroupofobesepatients.BMIwashigherinpatientsbeforesurgery(p<0.001).
PatientsfollowingLAGBdemonstratedprolongedgastricpouchemptying(T1/2=36.6+/9.8min)compared
tosubjectswithoutsurgery(23.8+/4.7min)andhealthyvolunteers(22.8+/6.8min;p<0.001).Similar
gastriccontractilitywasfoundallgroups(3.3+/0.4;p=0.968).Nocasesofbandslippageorpouchdilatation
wereobservedduringmeanfollowupof11.4months.CONCLUSIONS:Astandardnormalgastricpouch
emptyingrateofsemisolidsinasymptomaticpatientsafterLAGBwasestablished.Postoperativeprolongationof
gastricemptyingisamatterofmechanicaldelaywithoutgastricpouchdenervation.Thisstudyprovidesafirst
stepoffuturefunctionalevaluationofcomplicationsfollowingthistypeofbariatricsurgery.
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ObesSurg.2009Mar;19(3):2938.Epub2008Dec17.
Gastricemptyingisnotaffectedbysleevegastrectomyscintigraphic
evaluationofgastricemptyingaftersleevegastrectomywithoutremovalof
thegastricantrum.
BernstineH,TzioniYehoshuaR,GrosharD,BeglaibterN,ShikoraS,RosenthalRJ,RubinM.
DepartmentofNuclearMedicine,TelAvivUniversity,TelAviv,Israel.
BACKGROUND:Theaimofthisstudyistoclarifywhetherlaparoscopicsleevegastrectomy(LSG)totreatmorbid
obesitycauseschangesingastricemptying.METHODS:Gastricemptyingscintigraphywasperformedbeforeand
3monthsafterLSG,in21consecutivemorbidlyobesepatients.Afteranovernightfast,subjectsconsumeda
standardsemisolidmeal,towhich0.5mCiTc99labeledsulfurcolloidhadbeenadded.Themealwasconsumed
within10min.Scintigraphicimagingwasperformedwithagammacameraimmediatelyafterthecompletionof
themealaswellasafter30,60,120,180,and240min.Quantitativeandqualitativeanalysiswasperformedby
drawingaregionofinterest(ROI)enclosingthestomachontheanteriorandtheposteriorimages.Time0was
consideredthetimeofmealcompletion(alltheingestedactivity)andwasdefinedas100%retention.Thesame
ROIwasusedonallconsecutiveimagesofthesameprojectionforthesamepatient.Thegeometricmeanofthe
anteriorandtheposteriorcountsforeachtimepointiscalculatedandcorrectedforTc(99m)decay.Gastric
emptyingcurveswereconstructed.T1/2isthetimeintervalbetweencompletionofthemealandthepointat
whichhalfofthemeal(byradioactivitycounts)hasleftthestomach.Retentionisexpressedasthepercent
remaininginthestomachateachtimepoint(half,1,2,3,4h).RESULTS:ThemeanT1/2rawdatawas62.39+/
19.83and56.79+/18.72min(p=0.36,t=0.92,NS)beforeand3monthsafterLSG,respectively.TheT1/2linear
was103.64+/9.82and106.92+/14.55,(p=0.43,t=0.43,NS),andthelinearfitslope0.48+/0.04and0.47+/
0.05(p=0.48,t=0.7,NS).CONCLUSIONS:LSGwithantrumpreservationasperformedinthisserieshasnoeffect
ongastricemptying.
*****************************************************************************

Hepatobiliaryfunctionassessedby99mTcmebrofenincholescintigraphy
intheevaluationoffibrosisinchronichepatitis:histopathological
correlation.
KulaM,KaracavusS,BaskolM,DenizK,AbdulrezzakU,TutusA.
DepartmentsofaNuclearMedicinebGastroenterologycPatholgy,ErciyesUniversitySchoolofMedicine,Kayseri,
Turkey.
PURPOSE:AlthoughliverbiopsyremainsthegoldstandardinthestagingofliverfibrosisinchronichepatitisC
virus(HCV)infection,severalnoninvasivemethodsareunderevaluationforclinicaluse.Theaimofthisstudy
wastoevaluatetheutilityofhepatobiliaryfunctionthroughtechnetium99mN(3bromo2,4,6
trimethylacetanilide)iminodiaceticacid(Tcmebrofenin)scintigraphyinevaluatingliverfibrosisinpatients
withchronicHCVinfection.METHODS:Westudied62patientswithHCV(18men,44women).Thepatients
wereallocatedintothreegroupsaccordingtohistopathologicalscore:group1:portal/periportalfibrosis(21
patients;eightmen,13women);group2:bridgingfibrosis(23patients;sevenmen,16women);andgroup3:
incomplete/completecirrhosis(18patients;threemen,15women).Asacontrolgroup,20healthyvolunteers
(sixmenand14women)werestudied.Hepatocytemebrofeninuptakerate,thetimerequiredformaximal
hepaticactivity(Tmax),andthetimerequiredforpeakactivitytodecreaseby50%(T1/2max)werecalculated
usingTcmebrofenincholescintigraphy.Scintigraphicparameterswerecorrelatedwithbiochemicalparameters
andliverhistopathology.RESULTS:Theuptakeratesweresignificantlydecreasedinallgroupswithfibrosis
comparedwiththecontrols(P<0.05).ThecorrelationbetweentheseverityoffibrosisandTcmebrofenin
uptakeratewasstronglysignificant(r=0.81,P<0.0001).TmaxandT1/2maxweresignificantlyprolongedin
groups2and3comparedwiththecontrols.HistopathologyscorewascorrelatedmoderatelywithTmaxand
T1/2max(r=0.61,P<0.0001andr=0.52,P<0.0001,respectively).CONCLUSION:Theassessmentofhepatobiliary
functionbyTcmebrofeninscintigraphymaybeagoodchoiceforassessingtheseverityofliverfibrosisin
patientswithHCV.
*****************************************************************************
JNuclMed.2010Jan15.[Epubaheadofprint]
99mTcMebrofeninHepatobiliaryScintigraphywithSPECTforthe
AssessmentofHepaticFunctionandLiverFunctionalVolumeBefore
PartialHepatectomy.
deGraafW,vanLiendenKP,vanGulikTM,BenninkRJ.
DepartmentofSurgery,AcademicMedicalCenter,Amsterdam,TheNetherlands.
Preoperativeevaluationoffutureremnantliver(FRL)functioniscrucialinthedeterminationofwhethera
patientcansafelyundergoliverresection.Althoughdynamic(99m)Tcmebrofeninhepatobiliaryscintigraphy
(HBS)isusedtomeasureFRLfunction,2dimensionalplanarimageslacktheabilitytoassesssegmentalliver
function.ModernSPECT/CTcamerascombinedynamic(99m)TcmebrofeninHBSwithadditionalSPECTand
theanatomicinformationoftheCTscan.Theaimofthisstudywastoevaluatetheadditionalvalueof(99m)Tc
mebrofeninSPECTforthemeasurementofsegmentalliverfunctionandliverfunctionalvolume.METHODS:
PreoperativeCTvolumetryand(99m)TcmebrofeninHBSwithSPECTwereperformedin36patients
undergoingliverresection.In18patients,postoperative(99m)TcmebrofeninHBSwithSPECTwasperformed
within3dafteroperation.DualheaddynamicacquisitionswereusedtocalculateFRLfunctionusinganterior
andgeometricmean(Gmean)datasets.TotalandFRLfunctionallivervolumesweremeasuredbySPECT.
RESULTS:Becauseoftheanatomicpositionoftheliver,theanteriorprojectionresultedinanunderestimationof
FRLfunctioninpatientsundergoinglefthemihepatectomy.Inpatientswithnormalliverparenchyma,total
functionallivervolumewascomparabletototallivervolumemeasuredbyCTvolumetry,indicatingthat
(99m)TcmebrofeninSPECTisanaccuratemethodtomeasurehepaticvolume.Incompromisedlivers,
comparedwithnormallivers,FRLfunctionpercubiccentimeteroflivervolumewassignificantlyless.In
addition,liverfunctionwasnotdistributedhomogeneously,withthesegmentstoberesectedrelativelymore
affected.FRLfunction,measuredbyacombinationofSPECTanddynamicHBS,wasabletoaccuratelypredict
actualpostoperativeremnantliverfunction.CONCLUSION:TheGmeandatasetisrecommendedforthe
assessmentofhepaticfunctionbydynamicplanar(99m)TcmebrofeninHBS.ThecombinationofSPECTdata
withthedynamicuptakefunctionmeasuredbyplanarHBSprovidesvaluablevisibleandquantitative
informationregardingsegmentalliverfunctionandisanaccuratemeasureforFRLfunction.
PMID:20080899[PubMedassuppliedbypublisher
*****************************************************************************
Updateonhepatobiliaryimaging.
GaschenL.
SectionofDiagnosticImaging,DepartmentofVeterinaryClinicalSciences,LouisianaStateUniversity,Schoolof
VeterinaryMedicine,SkipBertmanDrive,BatonRouge,LA70803,USA.lgaschen@vetmed.lsu.edu
Radiographyandultrasonographyarethemostwellestablishedandfrequentlyusedimagingmodalitiesfor
diagnosinghepaticdiseaseinveterinarymedicine.Contrastenhancedharmonicultrasoundimagingoftheliver
isbeingestablishedinveterinarymedicinefortheassessmentofliverperfusion,hemodynamicalterationsinthe
presenceofportosystemicshunts(PSSs),anddifferentiationofbenignfrommalignanthepaticnodules.New
techniquesinnuclearmedicineincludesplenicportalscintigraphyandhepaticfunctiontests.CTisnowbeing
usedtodiagnosisPSSsnoninvasively.TherolesofCTandMRimaginginthediagnosisofhepaticdiseaseare
currentlybeingvalidated.Althoughlessbroadlyavailablethanultrasound,advancedimagingisbecomingmore
accessible,notonlythroughacademicinstitutions,butthroughtheincreasingnumberofspecialtypractices
worldwide.
*****************************************************************************
CitedByin
Scopus(0)
JournalofPediatricSurgery
Volume44,Issue10,October2009,Page2059
doi:10.1016/j.jpedsurg.2009.07.035|HowtoCiteorLinkUsingDOI
Copyright2009ElsevierInc.Allrightsreserved.
LettertotheEditor
MarkTulchinskyMDa,
aPennsylvaniaStateUniversity,Hershey,PA17033,USA
ArticleOutline
References
Ireadwithseriousconcernthe2articlesregardingbiliarydyskinesia(BD)publishedintheJournallastyear[1]
and[2].DiagnosisofBDreliedingreatmeasureongallbladderejectionfraction(GBEF)aftersincalide
stimulationonhepatobiliaryscintigraphy.However,bothstudiesfailedtoadequatelydescribehowsincalide
stimulationwasperformed.Adequatedescriptionconsistsofthetotalinjecteddose(microgramperkilogram)
andthetime(minutes)overwhichitwasinfused.Onearticleneglectedtomentionbothparameters[2],
whereastheotheronestatedaninaccuratetotaldoseonly[1].Thetotaldoseerror(1mg)inthelatterone
deservesaformalerratumstatementintheJournal.
Thetotaldoseofsincaliderecommendedbythedrugpackageinsertis0.02g/kgofbodyweight.Theinfusion
timehasnotbeenstandardized.However,itiswellknownthattheinfusiontimeof3minutesorshortercan
resultinGBEFlessthan35%,definedbybothstudiesasabnormal,inuptotwothirdsofnormalsubjects[3]and
[4].ThisshouldmakeallcliniciansparticipatinginthemanagementofBDpatientsclearabouthowexactly
diagnosticsincalideinfusionisperformedattheirinstitutionandexplicitwhentheywriteaboutit.
References
[1]S.Siddiqui,S.NewbroughandD.Altermanetal.,Efficacyoflaparoscopiccholecystectomyinthepediatric
population,JPediatrSurg43(2008),pp.109113[discussion13].Article| PDF(105K)|ViewRecordin
Scopus|CitedByinScopus(3)
[2]A.J.Kaye,M.JatlaandP.Matteietal.,Useoflaparoscopiccholecystectomyforbiliarydyskinesiainthechild,J
PediatrSurg43(2008),pp.10571059.Article| PDF(80K)|ViewRecordinScopus|CitedByinScopus(3)
[3]D.FinkBennett,P.DeRidderandW.Z.Kolozsietal.,Cholecystokinincholescintigraphy:detectionof
abnormalgallbladdermotorfunctioninpatientswithchronicacalculousgallbladderdisease,JNuclMed32
(1991),pp.16951699.ViewRecordinScopus|CitedByinScopus(65)
[4]H.A.Ziessman,L.R.MuenzandA.K.Agarwaletal.,Normalvaluesforsincalidecholescintigraphy:comparison
oftwomethods,Radiology221(2001),pp.404410.FullTextviaCrossRef|ViewRecordinScopus|CitedBy
inScopus(25)
JournalofPediatricSurgery
Volume44,Issue10,October2009,Page2059
JPediatrSurg.2009Oct;44(10):2059;authorreply205960.
DiagnosisofBDreliedingreatmeasureongallbladderejectionfraction
(GBEF)aftersincalidestimulationonhepatobiliaryscintigraphy.
TulchinskyM.
Commenton:
JPediatrSurg.2008Jan;43(1):10913;discussion113.
JPediatrSurg.2008Jun;43(6):10579.
PMID:19853777[PubMedindexedforMEDLINE
*****************************************************************************
ClinImaging.2009NovDec;33(6):43946.
Comparisonofdifferentdiagnosticmethodsfordifferentiatingbiliary
atresiafromidiopathicneonatalhepatitis.
YangJG,MaDQ,PengY,SongL,LiCL.
NuclearMedicineDepartmentofBeijingFriendshipHospitalAffiliatedtoCapitalMedicalUniversity,95YongAn
RoadXuanwuDistrict,Beijing100050,People'sRepublicofChina.
AIM:Toretrospectivelyanalyzedifferentmethodsindifferentiatingbiliaryatresiafromidiopathicneonatal
hepatitis.METHODS:Sixtynineinfantswithcholestaticjaundiceandfinaldiagnosisofidiopathicneonatal
hepatitis(INH)andbiliaryatresia(BA)werestudiedretroprospectivelyfromJanuary2004toDecember2006.
Athoroughhistoryandphysicalexaminationwereundertaken.Allcasesunderwentabdominalmagnetic
resonancecholangiography(MRCP),ultrasonography(US),hepatobiliaryscintigraphy(HBS),HBSsinglephoton
emissioncomputertomography(HBSSPECT),andoperationorpercutaneousliverbiopsy.Theaccuracy,
sensitivity,specificity,andpredictivevaluesofthesevariousmethodswerecompared.RESULTS:Therewere39
girlsand30boys,amongwhom35hadINH(age,61+/17days)and34hadBA(age,64+/18days).Themean
ageatonsetofjaundicewassignificantlylowerincasesofBAwhencomparedtoINHcases(9+/13vs.20+/21
days;P=.032).Thediagnosticaccuracyofdifferentmethodswasasfollows:liverbiopsy,97.1%;HBSSPECT,
91.30%;MRCP,71.01%;HBS,66.67%;US,65.22%.CONCLUSION:Ourresultsindicatethatbiopsyoftheliveris
consideredasthemostreliablemethodtodifferentiateINHfromBA.TheaccuracyofHBSSPECTishigherthan
thatofMRCP,HBS,andUS.TherewasnosignificantdifferenceindiagnosticaccuracyamongMRCP,HBS,andUS.
*****************************************************************************
JGastrointestSurg.2009Nov24.[Epubaheadofprint]
AssessmentofFutureRemnantLiverFunctionUsingHepatobiliary
ScintigraphyinPatientsUndergoingMajorLiverResection.
deGraafW,vanLiendenKP,DinantS,RoelofsJJ,BuschOR,GoumaDJ,BenninkRJ,vanGulikTM.
DepartmentofSurgery,AcademicMedicalCenter,P.O.Box22700,1100DE,Amsterdam,TheNetherlands.
BACKGROUND:(99m)Tcmebrofeninhepatobiliaryscintigraphy(HBS)wasusedasaquantitativemethodto
evaluateliverfunction.Theaimofthisstudywastocomparefutureremnantliverfunctionassessedby
(99m)Tcmebrofeninhepatobiliaryscintigraphywithfutureremnantlivervolumeinthepredictionofliver
failureaftermajorliverresection.METHODS:Computedtomography(CT)volumetryand(99m)Tcmebrofenin
hepatobiliaryscintigraphywereperformedpriortomajorresectionin55highriskpatients,including30
patientswithparenchymalliverdisease.Livervolumewasexpressedaspercentageoftotallivervolumeoras
standardizedfutureremnantlivervolume.Receiveroperatingcharacteristic(ROC)curveanalysiswas
performedtoidentifyacutoffvalueforfutureremnantliverfunctioninpredictingpostoperativeliverfailure.
RESULTS:Postoperativeliverfailureoccurredinninepatients.Aliverfunctioncutoffvalueof2.69%/min/m(2)
wascalculatedbyROCcurveanalysis.(99m)Tcmebrofeninhepatobiliaryscintigraphydemonstratedbetter
sensitivity,specificity,andpositiveandnegativepredictivevaluecomparedtofutureremnantlivervolume.
Using(99m)Tcmebrofeninhepatobiliaryscintigraphy,onecutoffvaluesufficesinbothcompromisedand
noncompromisedpatients.CONCLUSION:Preoperative(99m)Tcmebrofeninhepatobiliaryscintigraphyisa
valuabletechniquetoestimatetheriskofpostoperativeliverfailure.Especiallyinpatientswithuncertain
qualityoftheliverparenchyma,(99m)TcmebrofeninHBSprovedofmorevaluethanCTvolumetry.
*****************************************************************************
NipponHoshasenGijutsuGakkaiZasshi.2009Nov20;65(11):150211.
[Examinationofthemeansofmeasuringliverfunctioninthehepatobiliary
phase]
[ArticleinJapanese]
MoriH,FuruyaK,AkimotoS,AjiokaR,EmotoT.
DepartmentofRadiology,HokkaidoSocialInsuranceHospital.
Inafieldofcontrastenhancedmagneticresonanceimagingoftheliver,attentionhasbeenfocusedon
evaluationofliverfunctionusinggadoliniumethoxybenzyldiethylenetriaminepentaaceticacid(EOB).Inthis
study,weexaminedthepossibilityofobtainingliverfunctioninonlyonehepatobiliaryphase60minutesafter
injection.First,inregardtothedifferencebetweenthesignalintensityoftwomaterials,weexaminedtheeffects
ofslicegap,surfacecoilintensitycorrection(SCIC),andothers.Secondly,wecomparedthedifferencebetween
liverandspleensignalintensitywithbiochemicallaboratorytests,ChildPughclass,liverdamageclass,andthe
twoindices(HH(15)andLHL(15))calculatedby99mTcDTPAgalactosylhumanserumalbuminhepatic
scintigraphyinpatientswithchronicliverdiseases.Finally,wedesignatedthe"LiverEOBuptakeindex(L
EOB(60))"fromthoseresults,comparedwithHH(15)andLHL(15).Theresultsdemonstratedthatthe
differencebetweenthesignalintensityoftwomaterialsincreasedinthelackofslicegapexplainedbycrosstalk,
anddecreasedwithSCIC.Thedifferencebetweenliverandspleensignalintensitydecreasedwithworsened
liverandkidneyfunction.Inthecaseofslicegap>20%anddirectbilirubin<0.5mg/dLwithoutSCIC,the
correlationcoefficientbetweenLEOB(60)andLHL(15)was0.97.LEOB(60)wasstronglyproportionalto
LHL(15).WeconcludethatLEOB(60)meetingtheaboveconditionscanbeemployedasausefulindexto
determineliverfunction.
*****************************************************************************
CasesJ.2009Dec10;2:9300.
Hepatobiliaryscintigraphyinvasculitisofthegallbladderasa
manifestationofpolyarteritisnodosa:acasereport.
KitzingB,O'TooleS,WaughA,ClaytonJ,McGillN,AllmanKC.
DepartmentofPETandNuclearMedicine,RoyalPrinceAlfredHospital,MissendenRoad,Sydney,NewSouth
Wales,Australia.
INTRODUCTION:Polyarteritisnodosacanonrareoccasionsmanifestitselfasvasculitisofthegallbladder.
Patientstypicallypresentwithrightupperquadrantpainandareinitiallyworkedupforcholecystitis.The
definitivediagnosisisthenusuallybasedonsurgicalandhistopathologicalfindings.CASEPRESENTATION:In
thiscasea23yearoldCaucasianfemalepresentedwitha3weekhistoryofrightupperquadrantpainand
fevers.CONCLUSION:Theclinicalpathwayandimagingfindingsofararecaseofgallbladdervasculitisasa
manifestationofpolyarteritisnodosaaredemonstrated.
*****************************************************************************
JNuclMed.2010Jan15.[Epubaheadofprint]
99mTcMebrofeninHepatobiliaryScintigraphywithSPECTforthe
AssessmentofHepaticFunctionandLiverFunctionalVolumeBefore
PartialHepatectomy.
deGraafW,vanLiendenKP,vanGulikTM,BenninkRJ.
DepartmentofSurgery,AcademicMedicalCenter,Amsterdam,TheNetherlands.
Preoperativeevaluationoffutureremnantliver(FRL)functioniscrucialinthedeterminationofwhethera
patientcansafelyundergoliverresection.Althoughdynamic(99m)Tcmebrofeninhepatobiliaryscintigraphy
(HBS)isusedtomeasureFRLfunction,2dimensionalplanarimageslacktheabilitytoassesssegmentalliver
function.ModernSPECT/CTcamerascombinedynamic(99m)TcmebrofeninHBSwithadditionalSPECTand
theanatomicinformationoftheCTscan.Theaimofthisstudywastoevaluatetheadditionalvalueof(99m)Tc
mebrofeninSPECTforthemeasurementofsegmentalliverfunctionandliverfunctionalvolume.METHODS:
PreoperativeCTvolumetryand(99m)TcmebrofeninHBSwithSPECTwereperformedin36patients
undergoingliverresection.In18patients,postoperative(99m)TcmebrofeninHBSwithSPECTwasperformed
within3dafteroperation.DualheaddynamicacquisitionswereusedtocalculateFRLfunctionusinganterior
andgeometricmean(Gmean)datasets.TotalandFRLfunctionallivervolumesweremeasuredbySPECT.
RESULTS:Becauseoftheanatomicpositionoftheliver,theanteriorprojectionresultedinanunderestimationof
FRLfunctioninpatientsundergoinglefthemihepatectomy.Inpatientswithnormalliverparenchyma,total
functionallivervolumewascomparabletototallivervolumemeasuredbyCTvolumetry,indicatingthat
(99m)TcmebrofeninSPECTisanaccuratemethodtomeasurehepaticvolume.Incompromisedlivers,
comparedwithnormallivers,FRLfunctionpercubiccentimeteroflivervolumewassignificantlyless.In
addition,liverfunctionwasnotdistributedhomogeneously,withthesegmentstoberesectedrelativelymore
affected.FRLfunction,measuredbyacombinationofSPECTanddynamicHBS,wasabletoaccuratelypredict
actualpostoperativeremnantliverfunction.CONCLUSION:TheGmeandatasetisrecommendedforthe
assessmentofhepaticfunctionbydynamicplanar(99m)TcmebrofeninHBS.ThecombinationofSPECTdata
withthedynamicuptakefunctionmeasuredbyplanarHBSprovidesvaluablevisibleandquantitative
informationregardingsegmentalliverfunctionandisanaccuratemeasureforFRLfunction.
*****************************************************************************
Hepatobiliaryfunctionassessedby99mTcmebrofenincholescintigraphy
intheevaluationoffibrosisinchronichepatitis:histopathological
correlation.
KulaM,KaracavusS,BaskolM,DenizK,AbdulrezzakU,TutusA.
DepartmentsofaNuclearMedicinebGastroenterologycPatholgy,ErciyesUniversitySchoolofMedicine,Kayseri,
Turkey.
PURPOSE:AlthoughliverbiopsyremainsthegoldstandardinthestagingofliverfibrosisinchronichepatitisC
virus(HCV)infection,severalnoninvasivemethodsareunderevaluationforclinicaluse.Theaimofthisstudy
wastoevaluatetheutilityofhepatobiliaryfunctionthroughtechnetium99mN(3bromo2,4,6
trimethylacetanilide)iminodiaceticacid(Tcmebrofenin)scintigraphyinevaluatingliverfibrosisinpatients
withchronicHCVinfection.METHODS:Westudied62patientswithHCV(18men,44women).Thepatients
wereallocatedintothreegroupsaccordingtohistopathologicalscore:group1:portal/periportalfibrosis(21
patients;eightmen,13women);group2:bridgingfibrosis(23patients;sevenmen,16women);andgroup3:
incomplete/completecirrhosis(18patients;threemen,15women).Asacontrolgroup,20healthyvolunteers
(sixmenand14women)werestudied.Hepatocytemebrofeninuptakerate,thetimerequiredformaximal
hepaticactivity(Tmax),andthetimerequiredforpeakactivitytodecreaseby50%(T1/2max)werecalculated
usingTcmebrofenincholescintigraphy.Scintigraphicparameterswerecorrelatedwithbiochemicalparameters
andliverhistopathology.RESULTS:Theuptakeratesweresignificantlydecreasedinallgroupswithfibrosis
comparedwiththecontrols(P<0.05).ThecorrelationbetweentheseverityoffibrosisandTcmebrofenin
uptakeratewasstronglysignificant(r=0.81,P<0.0001).TmaxandT1/2maxweresignificantlyprolongedin
groups2and3comparedwiththecontrols.HistopathologyscorewascorrelatedmoderatelywithTmaxand
T1/2max(r=0.61,P<0.0001andr=0.52,P<0.0001,respectively).CONCLUSION:Theassessmentofhepatobiliary
functionbyTcmebrofeninscintigraphymaybeagoodchoiceforassessingtheseverityofliverfibrosisin
patientswithHCV.
*****************************************************************************
WorldJGastroenterol.2009Jun14;15(22):27637.
Gallbladderfunctionanddynamicsofbileflowinasymptomaticgallstone
disease.
CeriSS,OzbekFM,CeriC,BaykalB,EroluHE,BaykalZ,YildizM,SalamS,YeildaA.
DepartmentofNuclearMedicine,UniversityofSuleymanDemirelHospital,Isparta,Turkey.
sureyyacerci@hotmail.com
AIM:Toinvestigatetheeffectsofgallbladderstonesonmotorfunctionsofthegallbladderandthedynamicsof
bileflowinasymptomaticgallstonedisease.METHODS:Quantitativehepatobiliaryscintigraphywasperformed
todetecttheparametersofgallbladdermotorfunction[gallbladderejectionfraction(GBEF),gallbladder
visualizationtime(GBVT),gallbladdertimetopeakactivity(GBT(max)),gallbladderhalfemptyingtime
(GBT(1/2)),andtransittimeofbiletoduodenum(TTBD)]in24patientswithasymptomaticcholelithiasiswho
werediagnosedincidentallyduringroutineabdominalultrasonographicexaminationand20healthysubjects
withnormalgallbladder.RESULTS:Eventhoughtherewasnosignificantdifferenceintheclinicalandlaboratory
parametersbetweenthepatientandcontrolgroups,allparametersofgallbladderfunctionexceptTTBDwere
foundtodiffersignificantlybetweenthetwogroups.GBEFinthepatientgroupwasdecreased(P=0.000)and
GBVT,GBT(max),GBT(1/2)inthepatientgroupwerelonger(P=0.000,P=0.015,P=0.001,respectively).
CONCLUSION:Ourresultsshowedthateveniftherewerenotanyclinicalandlaboratoryfindings,gallbladder
fillingandemptyingcouldbeimpairedinpatientswithgallstonedisease.
*****************************************************************************
BestPractResClinGastroenterol.2009;23(3):44151.
Mandatoryandoptionalfunctiontestsforbiliarydisorders.
DauerM,LammertF.
DepartmentofMedicineII,SaarlandUniversityHospital,SaarlandUniversity,KirrbergerStr.,66421
Homburg/Saar,Germany.marc.dauer@uks.eu
Functiontestsingastroenterologyandhepatologyaimtoprovidecriteriafordiagnosisofspecificdisordersand
forpredictionofpatientresponsestotherapy.Thisreviewfocusesontheutilityoffunctiontestsinthe
managementofgallstonediseaseandfunctionalbiliarydisorders.Ingallstonedisease,functiontestsmaybe
consideredintheselectionofcandidatesfornonsurgicaltherapyofgallbladderstonesonly.Incasesof
suspectedfunctionalbiliarydisorders,expertshaveadvocatedtheuseofclassicalnoninvasivetestssuchas
hepatobiliaryscintigraphy.However,unequivocalevidencefortheirutilityindiagnosisorpatientselectionfor
invasivetreatmentisyettobeprovided.Recently,moreadvancednoninvasivetestssuchasrealtime
ultrasonographyorsecretinstimulatedmagneticresonancecholangiopancreaticographyhavebeendescribed.
Controlledtrialsusingthesenoveltechniquesmayprovidearationalefortheuseoffunctiontestsinclinical
managementofcalculousandacalculousbiliarydiseases,butarecurrentlynotavailable.
*****************************************************************************
ExpClinTransplant.2009Mar;7(1):404.
Portalhyperfusionorhepaticvenouscongestion:whichoneaffects
Kupffercellfunctionmore?
FiratO,MutlukocaN,MakayO,YilmazF,OmurO,KitapciogluG,YuzerY.
DepartmentGeneralSurgery,EgeUniversityHospital,Izmir,Turkey.ozgur.firat@ege.edu.tr
OBJECTIVES:Becauseoftheireffectsontheliverparenchymaaftersurgery,portalhyperperfusionandhepatic
venouscongestionarechallengingproblemsforhepatobiliarysurgeons.However,theeffectsofthoseconditions
onKupffercellshavenotbeenestablished.Theaimofthisstudywastoinvestigatetheeffectsofvascular
streamsmodifiedbyportalhyperperfusionandhepaticvenouscongestiononKupffercellfunction.MATERIALS
ANDMETHODS:Thirtyratswereallocatedinto3groupsof10ratseachandweresubjectedtorightportalvein
ligationtoinducehyperperfusionintheleftlobeoftheliver(group1),occlusionoftherighthepaticveinto
producevenouscongestion(group2),orshamoperation(controls;group3).After72hours,therightandleft
liverlobesofthesubjectsweresubmittedseparatelyforscintigraphicandhistopathologicevaluation,andthe
radiocolloiduptakepergramoflivertissueandthenumberofKupffercellspersquaremillimeterwere
calculated.RESULTS:Themeantechnetium99mlabeledsulfurcolloiduptakevaluesofthelivertissuepergram
were0.126/+0.038forgroup1,0.106/+0.032forgroup2,and0.110/+0.031forgroup3.Portal
hyperperfusionsignificantlyincreasedthetechnetium99mlabeledsulfurcolloiduptakeofthelivertissueper
gram(P=.043).ThemeannumberofKupffercellspersquaremillimeterwascalculatedforeachgroupas
follows:321/+094x106forgroup1,369/+083x106forgroup2,and355/+096x106forgroup3.Both
vascularstreamsproducednosignificanteffectsonthenumberofKupffercells(P>.05).CONCLUSIONS:Inthis
experimentalmodel,portalhyperperfusionaffectedKupffercellfunctionmorethandidhepaticvenous
congestion.
*****************************************************************************
Interventionsusedwithcholescintigraphyforthediagnosisof
hepatobiliarydisease.
ZiessmanHA.
DivisionofNuclearMedicine,RussellH.MorganDepartmentofRadiologyandRadiologicScience,JohnsHopkins
MedicalInstitutions,Baltimore,MD212780817,USA.hziessm1@jhmi.edu
Sincetheearly1980sinterventionshavebeenusedinconjunctionwith(99m)Tciminodiaceticacid(IDA)
radiopharmaceuticalsinmanydifferentclinicalsituations,eg,topreparethepatientforthestudy,toreducethe
timeofastudy,toimproveitsdiagnosticaccuracy,andtomakediagnosesnototherwisepossible.Interventions
allhaveunderlyingphysiologicalrationales.Someoftheseinterventionsareassimpleashavingthepatientfast
beforethestudyoreatamealwithhighfatcontent.However,mostarepharmacologicinterventions,eg,
morphinesulfate,cholecystokinin,andphenobarbital.Althoughtheseareprobablythemostcommon
interventionsusedtoday,numerousotherinterventionshavebeenusedduringtheyearsandlikelywillbein
thefuture.Interventionshaveaidedinthediagnosisofacutecholecystitis,chroniccholecystitis,biliary
obstruction,andsphincterofOddidysfunction.Thisreviewwilldiscussindetailtheinterventionscommonlyis
usetodayandinsomewhatlessdetailmanythathavebeensuccessfullyusedonaninvestigationalbasisand
mayhavesomelargerroleinthefuture.
*****************************************************************************
Nuklearmedizin.2009;48(3):1003.Epub2009Mar23.
99mTcsestamibiimagingcanitbeausefulsubstituteforhepatobiliary
scintigraphyininfantilejaundice?
SadeghiR,KianifarHR,KakhkiVR,ZakaviSR,AnsariK.
DepartmentofNuclearMedicine,ImamRezaHospital,MashhadUniversityofMedicalSciences,EbnSinaStreet,
Mashhad,Iran.sadeghir@mums.ac.ir
AIM:Hepatobiliaryscintigraphyisanintegralpartinthediagnosticworkupoftheneonatalcholestasis
syndrome.However,lessthanoptimalspecificityisitsmajordisadvantage.Differentiationbetweenbiliary
atresiaandneonatalhepatitisisnearlyimpossibleinsomecaseswithpoorhepatocellularfunction.99mTc
sestamibi(MIBI)isacationiclipophilicagentwhichisasubstrateofPglycoprotein.Thisglycoproteinis
normallyexpressedinbiliarycanalicularsurfacesofhepatocytes.Thispropertyprovidesahepaticexcretory
mechanismwhichisdifferentfrombilirubinexcretion.Inthisstudyweevaluatedthevalueof99mTcMIBIin
differentialdiagnosisofneonatalcholestasis.PATIENTS,METHODS:20infantswithameanageof2.41months
(range,0.15months)wereincludedinthestudy.Teninfantsturnedouttohaveextrahepaticbiliaryatresiaand
theothertenhadneonatalhepatitis.Hepatobiliary(with99mTcBrIDA)and99mTcMIBIscintigraphywere
performedforallthepatients.RESULTS:99mTcMIBIscintigraphyhasshownbowelactivityinallpatients,
includingthepatientswithbiliaryatresia.Hepatobiliaryscintigraphyrevealedbowelactivityonlyinfive
patientswithneonatalhepatitis.CONCLUSION:Bowelvisualizationwith99mTcMIBImaybeseeninpatients
withbiliaryatresiaand99mTcMIBIhaslimitedvalueindifferentialdiagnosisofneonatalcholestasis.
*****************************************************************************
TransplantProc.2009JanFeb;41(1):2017.
Nuclearimagingoftheliver:isthereadiagnosticroleofHIDAin
posttransplantation?
AlSofayanMS,IbrahimA,HelmyA,AlSaghierMI,AlSebayelMI,AboziedMM.
LiverTransplantationDepartment,KingFaisalSpecialistCenter&ResearchCenter,Riyadh,SaudiaArabia.
BACKGROUNDANDAIMS:Biliarycomplicationsarecommonafterlivertransplantation.Thisstudysoughtto
assessthevalueofhepaticiminodiaceticacid(HIDA)scans(hepatobiliaryiminodiaceticacidscan)todetect
earlyposttransplantationbiliarycomplications.METHODS:FromApril2003toJune2006,34liver
transplantations(recipientsofmean+/SDageof43.0+/15.7years)wereperformedin25(73.5%)males
from20(58.8%)cadavericdonorsand14(41.2%)livingrelateddonors.ThesubjectsunderwentHIDAscans
usingasingleheadgammacameraMeridian(Philips)afterintravenous(IV)administrationof185MBqTc99m
Disofenin.Themeantime+/SDposttransplantationtoHIDAscanwas14.6+/18.2days(range,074).The
resultswerecomparedwithendoscopicretrogradecholangiopancreatography,magneticresonant
cholangiopancreatography,percutaneouscholangiograhy,and/orliverbiopsy.RESULTS:Twentyfour
abnormalitiesweredetectedbyHIDAscanin16patients(47.1%):10(29.4%)biliaryleaks;4(11.4%)biliary
obstructionorcholestasis;1(2.9%)delayeduptake;5(14.7%)delayedbloodpoolclearance;and8(23.5%)
delayedtransittothebowel.Thecomplicationsweremorecommonamonglivingdonorcomparedwith
deceaseddonorgraftrecipients,albeitanotstatisticallysignificantdifference(P=.066).Totalanddirect
bilirubinlevelsweresignificantlyhigherinpatientswithabnormalthannormalHIDAscans(P=.011andP=
.040,respectively).ThesensitivityandspecificityofHIDAscanstodetectoverallpostoperativecomplications
were100%and66.7%,respectively.Biliaryleakresultswerefalsepositivesin7/10patients,andtruein3.
Detectionofobstructionwas75%sensitivebyHIDA.CONCLUSION:HIDAscansareanoninvasive,reliable
modalityforearlyexclusionofposttransplantationbiliarycomplications.However,correlationwithclinical
statusandimagingmodalitiesisessentialtoconfirmdetectedabnormalities.
*****************************************************************************
DigDisSci.2010Jan;55(1):1725.Epub2009Feb20.
Triangularcordsignindetectionofbiliaryatresia:isitavaluablesign?
ImaniehMH,DehghaniSM,BagheriMH,EmadV,HaghighatM,ZahmatkeshanM,ForutanHR,RasekhiAR,
GheisariF.
GastroenterohepatologyResearchCenter,NemazeeHospital,ShirazUniversityofMedicalSciences,Shiraz
7193711351,Iran.
BACKGROUND:Earlydetectionofbiliaryatresia(BA)hasavitalroleinpreventionoflivercirrhosisinthese
patients.Therearesomeevidencesthattriangularcord(TC)sign,i.e.,triangularstructurelocatedcranialtothe
portalveinbifurcationonultrasonographicexamination,issuggestiveofBAinsuspectedcases.Theaimofthis
studyistoevaluateandcomparethesensitivity,specificity,andaccuracyofTCsignwithothermethodsof
diagnosissuchashepatobiliaryscan.METHODS:Fiftyeightinfantsreferredtopediatricgastroenterologyward
withdiagnosisofinfantilecholestasisfromMarch2004toMarch2008wereevaluatedtofindthecauseof
cholestasis.Diagnosiswasmadebymeansofhistory,clinicalexamination,hepatobiliaryscan,andliverbiopsy.
UltrasonographicexaminationwasfocusedonpresenceofTCsigninpatients.Ifthediagnosiswasinfavorof
BA,patientwassentfordirectcholangiographyasagoldstandardtestforconfirmationofthediagnosis.The
sensitivity,specificity,andaccuracyofthetestswerecomparedwithgoldenstandard.RESULTS:Among58
infantswithinfantilecholestasis,BAwasdiagnosedandconfirmedin10infants(17.2%).Hepatobiliary
scintigraphyhad80%sensitivity,72.9%specificity,and74.1%accuracy.TCsignhad70%sensitivity,95.8%
specificity,and91.3%accuracy.CONCLUSION:TCsignismoreaccuratethanhepatobiliaryscanandhas
acceptablesensitivityandspecificityfordiagnosisofBA.
*****************************************************************************
ArchSurg.2009Feb;144(2):1807.
Metaanalysisofcholecystectomyinsymptomaticpatientswithpositive
hepatobiliaryiminodiaceticacidscanresultswithoutgallstones.
MahidSS,JafriNS,BrangersBC,MinorKS,HornungCA,GalandiukS.
PriceInstituteofSurgicalResearchandtheSectionofColorectalSurgery,DepartmentofSurgery,Universityof
Louisville,Louisville,KY40292,USA.

OBJECTIVE:Tostudytheclinicalresultsofsurgicalmanagementinpatientswithrightupperquadrantpain,a
positivehepatobiliaryiminodiaceticacid(HIDA)scanresult,andnogallstones.DATASOURCES:Healthcare
databasesandgrayliterature.STUDYSELECTION:Eacharticlewasscrutinizedtodeterminewhetheritmet
inclusioncriteria.Onlyabstracts,fullarticles,andgrayliteraturethatpassedthedetailedscreeningprocedure
wereincluded.Casereports,letters,comments,reviews,andabstractswithinsufficientdetailstomeetinclusion
criteriawereexcluded.GallbladderejectionfractionassessedbymeansotherthancholecystokininHIDAscan
werealsoexcluded.DATAEXTRACTION:Threereviewersindependentlyabstractedthefollowingdatafrom
eacharticle:firstauthor,yearofpublication,journal,typeofstudy,locationofstudypopulation,institution
wherethestudywasconducted,symptomsrecorded,imagingmodalityusedtoestablishtheabsenceof
gallstones,HIDAscanejectionfraction,numberofcasesandcontrols,numberofmalesandfemalesineach
group,methodoffollowup,andnumberofcaseslosttofollowup.DATASYNTHESIS:Tenstudiesmetinclusion
criteria(N=615).Followuprangedfrom3to64months.Surgicaltreatmentwas15foldmorelikelythan
medicaltreatmenttoresultinsymptomimprovement,with4%ofpatientsreportingnosymptomimprovement
withsurgery.Sensitivityanalysisinpatientswithcompletesymptomrelieffollowingsurgeryrevealedan8fold
greateroddsdifferencethanthosetreatedmedically(indicatingvariationinstudyreporting).CONCLUSIONS:
PatientswithoutgallstoneswhohaverightupperquadrantpainandapositiveHIDAscanresultaremorelikely
toexperiencesymptomrelieffollowingcholecystectomythanthosetreatedmedically.Thereis,however,wide
variabilityindatareporting,particularlywithrespecttosymptomreliefanddurationoffollowup.
CholecystectomyisindicatedinsymptomaticpatientswithoutgallstoneswhohavealowejectionfractionHIDA
scan.
*****************************************************************************
ComputMedImagingGraph.2009Apr;33(3):1826.Epub2009Jan7.
Evaluationofhepaticperfusionandfunctionwithmodifiedhepatobiliary
scintigraphy.
ChengMH,PanZH,LingYB,ZhangF,XuJH,ZhangY,HuangYX.
DepartmentofNuclearMedicine,ThirdHospitalAffiliatedSunYatsenUniversity,GuangZhou510630,
GuangdongProvince,China.marka@21cn.com
Thequantitativerelationshipbetweenchangesinportalveinpressureandtheperfusionindexwasstudied,and
hepatocellularfunctionwasevaluated.AmodifiedprotocolofhepatobiliarydynamicscintigraphywithTc99m
labeledethylenehepatobiliaryiminodiaceticacid(EHIDA)wasperformedin37patientswithhepaticcirrhosis
and12healthycontrols.In18patients,theportalveinpressure(PVP)wasmeasuredintraoperativelyduring
theportalveinbypassprocedure.Theportalveinperfusionindex(PVI)wasobtainedbyatwocompartment
modelofhepaticperfusion.Athreecompartmentmodelwasappliedinthehepatocellularextractedand
excretedtimeradioactivitycurves,andthehepaticfunctionalindexwascalculatedincludingthehepaticuptake
index(UI),themeanresidualindex(MRI),theuptakespeedindex(UsI),thedescentspeedindex(DsI),thepeak
uptake(PU),andthepeaktime(PT)ofhepaticuptake.Thesefunctionindicesinthecirrhoticpatientswere
comparedtotheindicesinthehealthycontrolswithatwosidedttest;specifically,thePU(18.94+/6.80vs.
29.67+/18.98,P<0.01),UI(0.84+/5.99vs.18.41+/13.87,P<0.05),andUsI(0.58+/0.39vs.1.23+/0.81,
P<0.01)wereslowerinpatientswithhepaticcirrhosiscomparedwiththehealthycontrols.ThePT(16.83+/
4.89vs.10.95+/2.79,P<0.001)andMRI(5.93+/2.96vs.2.74+/0.97,P<0.001)weremoreprolongedandthe
DsI(0.07+/0.09vs.0.18+/0.14,P<0.01)waslesscomparedtocontrols.ThePVIweresignificantlyhigherin
cirrhoticpatientsthanincontrols(46.17+/7.83vs.29.07+/5.71,P<0.001),andthePVIcorrelatedtothePVP
(r=0.79,P<0.01).Inconclusion,modifiedquantitativehepatobiliarydynamicscintigraphycanevaluatethe
changesofportalveinbloodflowandmonitorhepatocellularfunction,inwhichtheportalveinbloodflowcan
estimateportalveinpressure.
*****************************************************************************
AmJPhysiolGastrointestLiverPhysiol.2009Mar;296(3):G46175.Epub2009Jan15.
Methodsformeasurementofgastricmotility.
SzarkaLA,CamilleriM.
ClinicalEntericNeuroscienceTranslationalandEpidemiologicalResearch,MayoClinic,Charlton8110,200
FirstSt.S.W.,Rochester,MN55905,USA.

Thereisanarrayoftestsavailabletomeasuregastricmotility.Sometestsmeasureendpoints,suchasgastric
emptying,thatresultfromseveraldifferentfunctions,whereasothertestsaremorespecificandtestonlya
singleparameter,suchascontractility.Thisarticlereviewsthetestsmostcommonlyavailableinpracticeand
researchtoevaluateinvivothegastricfunctionsofemptying,accommodation,contractility,andmyoelectrical
activity.Therationalefortesting,therelativestrengthsandweaknessesofeachtest,andtechnicaldetailsare
summarized.Wealsobrieflyindicatetheapplicationsandvalidationsofthetestsforuseinexperimentalanimal
studies.
*****************************************************************************
Detectionofectopicgastricmucosausing99mTcpertechnetate:reviewof
theliterature.
KiratliPO,AksoyT,BozkurtMF,OrhanD.
DepartmentofNuclearMedicine,HacettepeUniversity,MedicalFaculty,06100Sihhiye,Ankara,Turkey.
pkiratli@hacettepe.edu.tr
Technetium99m((99m)Tc)pertechnetatescintigraphyinachildwithacutegastrointestinalbleedingof
unknownoriginsuggestsectopicgastricmucosacausedbyMeckel'sdiverticulumorgastrointestinalduplication
cysts.Ourobjectivewastodefinethepatternsofscintigraphicfindingslikelytobeencounteredinpatientswith
ectopicgastricmucosawithillustrativecasesandtoreviewtheliterature.Fiftychildren(age1yearto14years)
wereevaluatedforectopicgastricmucosausing(99m)Tcpertechnetatescintigraphy.Functioningectopic
gastricmucosawasdetectedineightpatientswithMeckel'sdiverticulaandthreepatientswithbowel
duplication.Threepatientsshowedatypicalfindingsonscintigraphywhichwereperforatedappendix,calyceal
stasis,andregionalenteritis.EctopicfunctioninggastricmucosainMeckel'sdiverticulumisvisualized
simultaneouslywiththestomach,whereasinintestinalduplicationstraceractivitycanbevisualizedinthe
dynamicsequenceorbeforegastrictracervisualizationinanirregularpattern.Avarietyofscintigraphic
patternscanbefoundinpatientswithectopicgastricmucosaundergoing(99m)Tcpertechnetatescintigraphy
dependingonthelocationandsizeoftheectopictissue.Also,acquisitionofdelayedimagesisusefulwhenthe
initialimagesareequivocalinchildren.
*****************************************************************************
GastrointestEndoscClinNAm.2009Jan;19(1):4955,vi.
Assessmentofgastricemptyingandsmallbowelmotility:scintigraphy,
breathtests,manometry,andSmartPill.
ParkmanHP.
TempleUniversitySchoolofMedicine,GastroenterologySection,ParkinsonPavilion,3401NorthBroadStreet,
Philadelphia,PA19140,USA.henry.parkman@temple.edu
Gastricandsmallboweldysfunctioncanincludegastroparesis,functionaldyspepsia,andevenirritablebowel
syndrome.Patientswithsymptomssuggestingthesedisordersarecommonlyencounteredbyavarietyof
physicians,especiallygastroenterologists.Inmostpatients,thephysicalexaminationandupperendoscopyare
normal,andthussymptomsaresuggestedtobefromamotilitydisorderorafunctionalgastrointestinal
disorder.Furtherevaluationdirectedatevaluatingthestomachandsmallbowelmotilitymayhelptheclinician
toarriveatacorrectdiagnosisenablingpropertreatmentofthepatient.Thisarticlecoversseveralteststhatare
usedtoevaluategastricandsmallbowelmotilityinpatients,eitherinclinicalevaluationorinclinicalresearch.
*****************************************************************************
Selectedinterventionsinnuclearmedicine:gastrointestinalmotor
functions.
OdunsiST,CamilleriM.
ClinicalEntericNeuroscienceTranslationalandEpidemiologicalResearch(CENTER)Group,CollegeofMedicine,
MayoClinic,Rochester,MN55905,USA.
Themeasurementofgastrointestinalfunctionsbytheuseofscintigraphyisestablishedinclinicalpracticeand
research.Themostcommonlyusedtestisthegastricemptyingtest,whichisacknowledgedasthegoldstandard
tomeasuregastricmotilityandisconductedaccordingtoaconsensusstatementfromthenationalnuclear
medicineandmotilitysocieties.Othertechniquesaresomewhatmoreesoteric(eg,measurementofgastric
accommodationwithsinglephotonemissioncomputedtomography)orthescintigraphicapproachisnotthe
acknowledgedgoldstandard(eg,colonictransit,rectoanalangle,andemptying,esophagealtransit).The
performancecharacteristicsofmanyofthescintigraphicmeasurementshavebeenpublishedandtheprosand
consestablishedintheliterature.Pharmacologicinterventionsmayalsobeusedduringscintigraphytoaidin
diagnosisandtreatment.Gastrointestinalscintigraphyisanintegralandimportantcomponentofthe
assessmentofgastrointestinalfunction.
*****************************************************************************
NeurogastroenterolMotil.2009Jul;21(7):706e38.Epub2009Feb27.
Optimizinganalysisofstableisotopebreathteststoestimategastric
emptyingofsolids.
OdunsiST,CamilleriM,SzarkaLA,ZinsmeisterAR.
ClinicalEntericNeuroscienceTranslationalandEpidemiologicalResearch(CENTER),MayoClinic,Rochester,
MN55905,USA.
Breathtests(BT)using13Csubstrateshavebeenproposedforthemeasurementofgastricemptying(GE).The
mathematicalanalysisofthebreath13CO2excretionthatmostaccuratelypredictsGEt(1/2)fromsimultaneous
scintigraphyisunresolved.TocomparefivemathematicalmethodstoestimateGEt(1/2)byBTwitht(1/2)from
simultaneousscintigraphy.Dataacquiredfromaduallabelledsolidliquidmealcontaining99mTcsulphur
colloidand13CSpirulinaplatensisfrom57healthyvolunteerswereusedtocomparefourmathematical
methodsreportedintheliterature[Ghoosmethod;generalizedlinearregression(Viramontes);linearregression
(Szarka);WagnerNelsonmethod]andthetotalcumulativebreath13CO2excretionwith>or=12breath
samplescollectedoveratleast4h.Theconcordancecorrelationcoefficient(CCC)forthet(1/2)resultsobtained
witheachmethodusingBTdatawascomparedwiththeresultsobtainedwithscintigraphy.Thelinear
regressionandgeneralizedlinearregressionmethodsusedfivesamplesat45,90,120,150and180min.All
methods,exceptfortheWagnerNelsonmethod,resultedinmeanGEt(1/2)thatapproximatedt(1/2)obtained
withscintigraphy.ThehighestCCCwasobservedwiththelinearregressionmethod.Simplecumulative
excretionofbreath13CO2providesabetterCCCthantheGhoosmethod.Thelinearregressionandgeneralized
linearregressionmethods(whichalsorequirerelativelyfewbreathsamples)providethemostaccurate
analysesofbreath13CO2excretioninstableisotopeGEBT.
*****************************************************************************
MethodsFindExpClinPharmacol.2008Dec;30(10):7536.
ParacetamolabsorptiontestwithWagnerNelsonanalysisforsafeand
accuratemeasurementsofgastricemptyinginwomen.
SanakaM,NakadaK.
DepartmentofGeneralMedicineandEmergencyCare,TohoUniversitySchoolofMedicine,Tokyo,Japan.
sanakam@med.tohou.ac.jp
Thephysiologicalandpharmacologicalaspectsofgastricemptyinginfertileorpregnantwomenhavebeen
studied.Scintigraphyisthereferencemethodformeasuringgastricemptying.However,itshouldbeapplied
verycautiouslytowomenofchildbearingagebecauseoftheriskofsubstantialirratiation.Insuchapopulation,
paracetamolabsorptionhasbeenusedsafelyasanindexofgastricemptying,butitsaccuracyhasbeen
challenged.TheWagnerNelsonmethodisatraditionaltoolusedtopreciselyevaluatedrugabsorptionkinetics.
ToclarifywhethertheabsorptionkineticsofparacetamolassessedbytheWagnerNelsonmethodisasaccurate
asscintigraphyinevaluatinggastricemptyinginyoungwomen,gastricemptyingofa200kcalliquidmealwas
measuredsimultaneouslybyscintigraphyandtheparacetamoltestin10healthyyoungfemalevolunteers.
Paracetamolabsorptionsystemicallyoverestimatedtherateofgastricemptyingmeasuredbyscintigraphy.By
introducingacorrectionfactorintotheparacetamoltest,theoverestimationcouldbeadjusted.Theparacetamol
testwithWagnerNelsonanalysiscanbeasafeandaccuratemethodformeasuringgastricemptyinginwomen
ofchildbearingage.Copyright2008ProusScience,S.A.U.oritslicensors.Allrightsreserved.
*****************************************************************************
Gastroenterology.2009Aug;137(2):44552.Epub2009May4.
Delayedradionucleotidegastricemptyingstudiespredictmorbidityin
diabeticswithsymptomsofgastroparesis.
HyettB,MartinezFJ,GillBM,MehraS,LemboA,KellyCP,LefflerDA.
DivisionofGastroenterology,BrighamandWomen'sHospital,Boston,Massachusetts02215,USA.
bhyett@partners.org
BACKGROUND&AIMS:Theaimofthisstudywastoevaluatetheprognosticvalueofgastricemptyingstudieson
themorbidityassociatedwithdiabeticgastroparesis.METHODS:Thiswasaparallelcohortstudyof3groups.
GroupA(n=94)containeddiabeticpatients(type1andtype2)withclassicsymptomsofgastroparesis
(includingearlysatiety,postprandialfullness,bloating,abdominalswelling,nausea,vomiting,andretching)and
delayinradionucleotidegastricemptyingstudy.GroupB(n=94)containeddiabeticsubjectswithclassic
symptomsofgastroparesisbutnegativescintigraphy.GroupC(n=94)containeddiabeticsubjectswithout
symptomsofgastroparesis.Dataweregatheredonthenumberofdayshospitalizedandhospitalizations,office
visits,emergencydepartmentvisits,deathrate,glycosylatedhemoglobinlevels,medications,andpastmedical
history.RESULTS:GroupAhadsignificantlymorehospitaldaysper1000patientdays(25.5)thanbothgroupB
(5.1;P<.01)andgroupC(2.3;P<.01).GroupAalsohadsignificantlymorehospitalizations,officevisits,and
emergencydepartmentvisitsthanbothgroupBandgroupC.Deathsandmeanglycosylatedhemoglobinlevels
didnotdifferbetweenthegroups.PatientsingroupAweremorelikelytohavecardiovasculardisease(19.2%
vs6.4%,AvsC;P<.05),hypertension(63%vs43%,AvsC;P=.005),andretinopathy(33%vs11.7%,AvsC;P
<.001).CONCLUSIONS:Adelayedradionucleotidegastricemptyingstudypredictsnegativehealthoutcomesin
diabeticpatientswithsymptomsofgastroparesis.Weidentifiedacorrelationbetweendiabeticgastroparesis
andcardiovasculardisease,hypertension,andretinopathythatmayindicateanunderlyingvascularetiology.
*****************************************************************************
JNuclMed.2009May;50(5):72631.Epub2009Apr16.
Theaddeddiagnosticvalueofliquidgastricemptyingcomparedwithsolid
emptyingalone.
ZiessmanHA,ChanderA,ClarkeJO,RamosA,WahlRL.
RussellH.MorganDepartmentofRadiologyandRadiologicalSciences,JohnsHopkinsMedicalInstitutions,
Baltimore,MD,USA.hziessm1@jhmi.edu
Themedicalliteraturestatesthatsolidgastricemptyingstudiesaremoresensitiveforthedetectionof
gastroparesisthanareliquidstudies;thus,liquidstudiesarerarelyrequired.However,wehaveseenpatients
withnormalsolidbutdelayedliquidemptying.Thepurposeofthisinvestigationwastodeterminewhethera
studyofclearliquidgastricemptyinghasaddedvalueforthediagnosisofgastroparesisoverastudyofsolid
emptyingalone.METHODS:Atotalof101patientsunderwentbothsolidandliquidgastricemptyingstudies,
acquiredsequentiallyonthesameday.A30min(1minframes)liquidstudy(300mLofwaterwith7.4MBq
[0.2mCi]of(111)Indiethylenetriaminepentaaceticacid)wasfollowedbyastandardized4hsolidmealstudy(a
(99m)Tcsulfurcolloidlabeledeggsubstitutesandwichmeal).Emptyingwasquantifiedasabestfitexponential
emptyingrate(T1/2)forliquidsandpercentageemptyingat4hforsolidemptying.Thirtyhealthyvolunteers
underwentastudyofclearliquidemptyingtoestablishnormalvalues.Theresultsoftheliquidandsolidstudies
werecompared.(111)Inliquiddownscatterintothesubsequent(99m)Tcsolidmealresultswasanalyzed.
RESULTS:Theupperrangeofnormalforclearliquidemptying(T1/2)forhealthyvolunteerswas22min(mean
+/3SDs)and19min(mean+/2SDs).Of101patients,delayedemptyingwasfoundin36%ofliquidand16%
ofsolidstudies.Ofallpatientswithnormalsolidemptying,32%haddelayedliquidemptying.(111)In
downscatterintothe(99m)Tcwindowwasnotgenerallysignificant.CONCLUSION:Forthedetectionof
gastroparesis,a30minstudyofclearliquidgastricemptyinghasconsiderableaddeddiagnosticvalueovera
studyofsolidemptyingalone.
*****************************************************************************
ClinNuclMed.2009Mar;34(3):1912.
DetectionofsplenomegalyonMeckel'sdiverticulumscan.
MirpourS,GholamrezanezhadA,AnsariGilaniK,SaghariM.
DepartmentofNuclearMedicine,Children'sHospitalMedicalCenter,TehranUniversityofMedicalSciences,
Tehran,Iran.
A16yearoldboywasseenwiththecomplaintofintermittentlowergastrointestinalbleedingandwasreferred
foraradionuclideMeckelogram.AlthoughTc99mpertechnetatescintigraphyfailedtorevealheterotopic
gastricmucosa,focalaccumulationofradiotracerinalargeareainvolvingtheleftsideoftheabdomenandliver
wereseen.Bothareasofactivityclearedgradually,butthefirstoneremainedlongerandbasedonits
configuration,raisedthepossibilityofsplenomegaly.Furtherultrasonographicevaluationconfirmedthe
diagnosisofsplenomegaly,whichwassubsequentlydeterminedtobesecondarytononcirrhoticportalfibrosis.
ThefindingsofradionuclideMeckelogramscanbemorethandetectingheterotopicgastricmucosa.
*****************************************************************************
ClinNuclMed.2009Mar;34(3):15860.
"Meckelscan"findingsinaninfantwithileocolicintussusception.
MalhotraG,AsopaR,ShahH,JoshiM,BaghelNS.
RadiationMedicineCentre,BhabhaAtomicResearchCentre,Mumbai,India.maloonucmed@yahoo.com
A7montholdmaleinfantwhopresentedwithbleedingperrectumwasevaluatedanddiagnosedtohave
ileocolicintussusceptiononultrasonography.Despiteultrasonographyguidedsalinereduction,therewas
persistenceofbleedingperrectum.HewasgivenbloodtransfusionandreferredforTc99mpertechnetatescan
toruleoutectopicgastricmucosa.Thescanwasdoneasperthestandardinstitutionprotocolandtheimages
revealedafocusofprogressivelyincreasingtraceruptakeintherightlowerabdominalquadrantsuggestingthe
presenceofectopicgastricmucosa.Anexploratorylaparotomyrevealedileocolicintussusceptionsecondaryto
Meckeldiverticulumactingasapathologicleadpoint(PLP).Awedgeresectionoftheintestinalwallcontaining
thediverticulumwithsutureclosurewasperformed.ThepresenceofMeckeldiverticulumandectopicgastric
mucosawasconfirmedonsubsequenthistopathologicalexaminationofthespecimen.Thepatientrapidly
improvedpostoperativelyandwasdischarged9daysaftersurgery.Bleedingperrectumcanbeseeninboth
intussusceptionandinMeckeldiverticulumwithectopicgastricmucosa.Intussusceptionoriginatingfroma
MeckeldiverticulumasPLPremainsadiagnosticchallengebecauseoftheoverlappingsymptoms.TheMeckel
scanfindings,inthiscase,avoidedthefurtherCTscan,angiography,andendoscopyforthediagnosisofthe
causeofsymptoms,sparingnotonlythetimebutcostofinvestigationsandunnecessaryradiationexposureto
thepatient.
*****************************************************************************
*****************************************************************************
Hepatogastroenterology.2009MayJun;56(9192):91820.
Doespostprandialcoffeeintakeenhancegastricemptying?:acrossover
studyusingcontinuousrealtime13Cbreathtest(BreathIDsystem).
AkimotoK,InamoriM,IidaH,EndoH,AkiyamaT,IkedaT,FujitaK,TakahashiH,YonedaM,GotoA,AbeY,
KobayashiN,KirikoshiH,KubotaK,SaitoS,NakajimaA.
GastroenterologyDivision,YokohamaCityUniversitySchoolofMedicine,Yokohama,Japan.
BACKGROUND/AIMS:Coffeeisoneofthemostpopularbeveragesworldwide,however,fewstudieshave
examinedtheeffectsofcoffeeonthegastrointestinalsystem.Theaimofthisstudywastodeterminewhether
therewasacorrelationbetweencoffeeintakeandgastricemptyingusinganovelnoninvasivetechniquefor
measuringgastricemptyingwithacontinuousrealtime13Cbreathtest(BreathIDsystem:Oridion,Israel).
METHODOLOGY:Sixhealthymalevolunteersparticipatedinthisrandomized,twowaycrossoverstudy.The
subjectswererandomlyassignedtoreceiveatestmeal(200kcalper200mL)pluspostprandial190mLblack
coffeeorthetestmealaloneafterfastingovernight.A13Caceticacidbreathtestwascontinuouslyperformed
usingtheBreathIDsystem,whichmonitorsgastricemptying,for4hoursaftertheadministrationofthetest
meal.UsingOridionResearchSoftware(betaversion),thetimeforemptyingof50%ofthelabeledmeals(T1/2)
andtheanalogtothescintigraphylagtimefor10%emptyingofthelabeledmeal(Tlag)werecalculated.The
parametersbetweentwooccasionswerecomparedusingtheWilcoxonsignedranktest.RESULTS:Aftercoffee
intaketheT1/2andTlagconstantweresignificantlydecreased.CONCLUSIONS:ThedecreaseintheT1/2and
Tlagsuggeststheaccelerationofgastricemptying.Thisstudyshowedthatpostprandialcoffeeintakeenhances
gastricemptying,suggestingthepotentialuseofcoffeeinclinicalsettingsforpatientswithfunctional
gastrointestinaldisorders.
*****************************************************************************
GastrointestEndosc.2009Sep;70(3):5617.Epub2009Jul4.
RadiationmicrosphereinducedGIulcersafterselectiveinternalradiation
therapyforhepatictumors:anunderrecognizedclinicalentity.
KondaA,SavinMA,CappellMS,DuffyMC.
DepartmentofGastroenterologyandHepatology,WilliamBeaumontHospital,RoyalOak,Michigan,USA.
BACKGROUND:Intraarterialinfusionofyttrium90(Y90)microspheresislocoregionalradiationtherapyfor
unresectablehepaticneoplasms.LiteratureonGIcomplicationsofthisnoveltherapyissparse.OBJECTIVES:
Clinicallyandpictoriallycharacterizeselectiveinternalradiationtherapy(SIRT)inducedGIinjuryandreview
thepublishedliterature.DESIGN:Retrospectivechartanalysis.SETTING:Singlecentertertiaryreferral
communityhospital.PATIENTS:OnehundredthreepatientstreatedwithSIRTforhepaticneoplasmsbetween
2006and2008.INTERVENTIONS:SIRTforunresectablehepaticneoplasmsfollowedbyupperendoscopywith
biopsyinsymptomaticpatients.OUTCOMEMEASURES:GIulcersafterSIRT.RESULTS:Fivepatientswith
suspectedGIinjuryafterSIRTwereidentified.Significantpostproceduralsymptomsincludednausea/vomiting,
odynophagia,hematemesis,andmelena.Radiationulcersoccurredmostlyinthegastricantrum,pylorus,and
duodenum.Biopsyspecimensofulcermarginsin4patientsshowedpathognomonicradiationmicrospheres.
Angiographicreviewofthefifthpatientrevealedapreviouslyunrecognizedarterialbranchsupplyingthe
correspondingregionofGIulcerationnotedonendoscopy.LIMITATIONS:Smallretrospectivestudyandfollow
uplimitedbyterminaldiseasestatesinmostpatients.CONCLUSIONS:ThereportedincidenceofGI
complicationsafterSIRTforhepaticneoplasiavariesfrom3%to24%ofpatients.Incidencecanbeminimized
bystrictadherencetopublishedSIRTprotocols.Diagnosisrequiresahighdegreeofclinicalsuspicionalongwith
endoscopyandbiopsyofulcermargins.Characteristicradiationmicrospheresinbiopsyspecimensare
pathognomonic.Gastroenterologistsandpathologistsmustbecognizantofthiscomplication.
*****************************************************************************
BestPractResClinGastroenterol.2009;23(3):28798.
Gastrointestinalmotilitytesting.
SmoutAJ,MundtMW.
DepartmentofGastroenterologyandHepatology,UniversityMedicalCenterUtrecht,POBox85500,3508GA
Utrecht,TheNetherlands.asmout@umcutrecht.nl
Gastrointestinalmotilityandtheeffectsonluminalcontentsthatarebroughtaboutbyitcanbestudiedin
severalways.Inclinicalpractice,manometryremainsoneofthemostimportantinvestigationaltechniques,in
particularforoesophagealandanorectaldisorders.Radiographicexaminationofbolustransitthroughthe
gastrointestinaltractalsocontinuestobeavaluabletool.Scintigraphystillisthegoldstandardforassessmentof
gastricemptying,but(13)(C)breathtestsareanalternative.Manyothertechniquesareusedmainlyinthe
contextofscientificresearchbutsomeofthesemaybecomeincorporatedinthediagnosticarmamentarium.
*****************************************************************************
PediatrSurgInt.2009Jul;25(7):55972.Epub2009Jun2.
Colonictransitstudies:normalvaluesforadultsandchildrenwith
comparisonofradiologicalandscintigraphicmethods.
SouthwellBR,ClarkeMC,SutcliffeJ,HutsonJM.
SurgicalResearchGroup,GutMotilityLaboratory,MurdochChildren'sResearchInstitute,RoyalChildren's
Hospital,Parkville,VIC3052,Australia.bridget.southwell@mcri.edu.au
Thesitzorplasticmarkerstudyforcolonictransithasbeenaroundformanyyears.ItisapplicablewhereanX
raymachineexists,iswidelyusedandisacceptedasthegoldstandardfordiagnosingconstipation.Recently,
radiopharmaceuticalmethodshavebeendeveloped.Thethemeofthisreviewistheirpossiblerolesinthe
assessmentofpaediatricbowelmotilitydisordersinpatientspresentingtopaediatricsurgeons.Thisreview
presentsdataontotalandsegmentaltransitinnormaladultsandchildrenandcomparingthetwotechniquesin
adults.Reliabilityandreproducibilityarepresented.Normativedataforcolonictransitinadultsandchildren
arediscussedandparametersforassessingabnormaltransitarereviewed.Normalcolonictransittakes2056h.
Plasticmarkerstudiesaremorereadilyaccessible,buttheassessmentmaybemisleadingwithcurrentmethods.
Plasticmarkersshowfastertransitthanscintigraphy.Itisdifficulttocomparethetwotechniquesbecause
methodsofreportingaredifferent.Usingscintigraphy,repeatabilityisgood.Separationofnormalfromslow
transitintheascendingcolonisapparentat24and48h,butthedeterminationoftransitthroughthedistal
colon/rectuminadultsmayrequirestudiesofmorethan7days.Inconclusion,plasticmarkerstudiesand
scintigraphyshowsimilartransitratesinyoungadultsandchildren.However,scintigraphyhasadvantagesof
allowingtransitthroughthestomachandsmallintestinetobemeasuredandhasprovedusefulinthediagnostic
workupofchildrenwithintractableconstipation.
*****************************************************************************
Hepatogastroenterology.2009JulAug;56(93):10538.
Detectionofgastrointestinalandabdominalinfectionsby99mTc
antigranulocyteantibodies.
ArtikoV,PetroviM,SobiSaranoviD,KrajnoviJaksiE,TuliC,MilovanoviJ,DjukiV,RankoviV,MatiS,
AntiA,RadomanI,LauseviZ,StojkoviM,PavloviS,ObradoviV.
InstituteforNuclearMedicine,ClinicalCenterofSerbia,Visegradska26,11000Beograd,Serbia.
veraart@beotel.yu
BACKGROUND/AIMS:Theaimofthestudywasdetectionofabdominalinfectionsby99mTcantigranulocyte
antibodies.METHODOLOGY:Totalof36patientswithclinicalsuspiciononabdominalorgastrointestinal
infectionswasinvestigated.RESULTS:Therewere23truepositive(TP)findings(onepulmonaryabscess,2
subhepaticabscessesaftersurgery,2perianalfistula,2chronicand4acuteappendicitis,5abdominaland3
pelvicabscesses,3M.Crohn,oneulcerativecolitis),9truenegative(TN)(3tumorsofthecoecum,2tumorsof
papillaWateri,2gastriccarcinoma,2coloncarcinoma),and4falsenegative(FN)(2abscessessubphrenicand2
enterocolicfistula).Falsepositive(FP)findingswerenotobserved.Thesmallestlesionfoundwas19x18mm.
SPECTincreasedthenumberofTPfindingsfrom17to23.Fifteenof23infectiousofinflammatorylesionscould
bedetectedintheearlyscan.Sensitivitywas85%,specificity100%,positivepredictivevalue100%,negative
predictivevalue69%andaccuracy89%.CONCLUSION:Accordingtothepresentresults,scintigraphywith
99mTcantigranulocyteantibodiesisausefulmethodfordetectionandassessmentofexactlocalization
abdominalinfections,whichisveryimportantforthepromptandappropriatetherapy.
*****************************************************************************
NeurogastroenterolMotil.2009Oct;21(10):10136.
Willthe13Coctanoicacidbreathtesteverreplacescintigraphyasthegold
standardtoassessgastricemptying?
VerbekeK.
DepartmentofGastrointestinalResearch,UniversityofLeuven,Leuven,Belgium.
kristin.verbeke@uz.kuleuven.be
Theapplicabilityofthe13Coctanoicacidbreathtestfortheassessmentofgastricemptyingisdiscussed.Inthe
currentissueofthisjournal,Kellerandhercolleaguesdescribedtheapplicationofdifferentmathematical
modelsforanalysisofthe13Coctanoicacidtestinaverylargepatientpopulation.
*****************************************************************************
DigDisSci.2009Oct;54(10):216774.Epub2009Aug5.
Wirelesscapsulemotility:comparisonoftheSmartPillGImonitoring
systemwithscintigraphyformeasuringwholeguttransit.
MaqboolS,ParkmanHP,FriedenbergFK.
GastroenterologySection,DepartmentofMedicine,8thFloorParkinsonPavilion,TempleUniversitySchoolof
Medicine,Philadelphia,PA19140,USA.
INTRODUCTION:Assessmentofwholeguttransit,byradioopaquemarkersorscintigraphy,isusedtoevaluate
patientswithconstipationforslowgastrointestinaltransit.Wirelesscapsulemotility,usingtheSmartPillGI
monitoringsystem,samplesandtransmitsintraluminalpH,pressure,andtemperaturedatafromacapsuleat
regularintervalsasittraversesthroughthegastrointestinaltract;fromthese,gastricemptyingandwhole
gastrointestinaltracttransitcanbeassessed.TheobjectiveofthisstudywastocomparetheSmartPillwith
wholeguttransitscintigraphytodeterminewhethertheSmartPillsystemcouldserveasatestformeasurement
ofwholegutmotilityandtransit.METHODS:Tenhealthy,asymptomaticsubjectsunderwentsimultaneous
wholegutscintigraphyandSmartPillassessmentofwholeguttransit.RESULTS:Allsubjectscompletedthe
studyperprotocolandexperiencednaturalpassageofthepill.Capsuleresidencetimeinthestomachcorrelated
verystronglywithpercentgastricretentionoftheTc99radiolabelat120min(r=0.95)andat240min(r=
0.73).Smallbowelcontractionmin(1)measuredbytheSmartPillcorrelatedwithsmallboweltransit%(r=
0.69;P=0.05)andwithisotopiccolonicgeometriccenterat24hafteringestion(r=0.70,P=0.024).Capsule
transittimecorrelatedwithscintigraphicassessmentofwholeguttransit.CONCLUSIONS:SmartPillcapsule
assessmentofgastricemptyingandwholeguttransitcomparesfavorablywiththatofscintigraphy.Wireless
capsulemotilityshowspromiseasausefuldiagnostictesttoevaluatepatientsforGItransitdisordersandto
studytheeffectofprokineticagentsonGItransit.
*****************************************************************************
NeurogastroenterolMotil.2010Jan18.[Epubaheadofprint]
Assessmentofsymptomsduringgastricemptyingscintigraphytocorrelate
symptomstodelayedgastricemptying.
KhayyamU,SachdevaP,GomezJ,RamzanZ,SmithMS,MaurerAH,FisherRS,ParkmanHP.
SectionofGastroenterology,DepartmentofMedicine,TempleUniversitySchoolofMedicine,Philadelphia,PA,
USA.
AbstractBackgroundSymptomsofgastroparesisbasedonpatientrecallcorrelatepoorlywithgastricemptying.
Theaimofthisstudyistodetermineifsymptomsrecordedduringgastricemptyingscintigraphy(GES)correlate
withgastricemptyingandwithsymptomsbasedonpatientrecall.MethodsPatientsundergoingGEScompleted
thePatientAssessmentofGISymptoms(PAGISYM)assessingsymptomsovertheprior2weeksanda
questionnaireforwhichpatientsgradedsixsymptomsduringGES.ASymptomSeverityIndex(SSI)represented
themeanofsixsymptomsateachtimepoint.KeyResultsAtotalof560patientsunderwentGESforclinical
evaluationofsymptoms.Of388patientsincludedinthestudy:232patientshadnormalGES(NGES),156
delayedGES(DGES),and11rapidGES(RGES).Symptomseverityindexincreasedpretopostprandialforeach
group:NGES:0.51+/0.07to0.92+/0.03,DGES:0.60+/0.09to1.13+/0.05,andRGES:0.56+/0.12to0.79
+/0.13.DelayedgastricemptyingscintigraphypatientshadahigherpostprandialSSIthanNGESpatients(1.13
+/0.05vs0.92+/0.03,P<0.05).Postprandialsymptomsofstomachfullness(1.9+/0.12vs1.5+/0.09;P=
0.011),bloating(1.4+/0.11vs1.1+/0.09;P=0.033),andabdominalpain(1.1+/0.08vs0.7+/0.12;P=
0.012)werehigherinDGESthanNGES.SymptomseveritybasedonPAGISYMfor2weekspriortoGES
correlatedwithsymptomsduringthetestfornausea(NGES,r=0.61;DGES,r=0.70),stomachfullness(NGES,r
=0.47;DGES,r=0.60),andbloating(NGES,r=0.62,DGES,r=0.66).Conclusions&InferencesStomachfullness,
bloating,andabdominalpainrecordedduringGESwerehigherinpatientswithdelayedgastricemptyingthanin
patientswithnormalgastricemptying.SymptomsrecordedduringGEScorrelatedwiththoseduringdailylifeby
patientrecall.
*****************************************************************************
Utilityofwholeguttransitscintigraphyinpatientswithchronic
gastrointestinalsymptoms.
BalanK,AlwisL,SonodaLI,PawarooD,ParryJonesDR,MiddletonS.
DepartmentsofNuclearMedicineandGastroenterology,Addenbrooke'sHospital,Cambridge,UK.
BACKGROUND:Toreviewourexperienceofdoingwholeguttransitscintigraphyinpatientspresentingwith
functionalgastrointestinalproblemsandtodetermineitsclinicalusefulness.METHOD:Allwholeguttransit
studiesusingaliquidmealovera5yearperiodwerereviewedandclinicaloutcomeassessed.RESULTS:Fifty
fivepatients(44women;meanage43years)underwentwholeguttransitscintigraphyusingindium111
diethylenetriaminepentaaceticacidinwater.Themainsymptomswereconstipation(49%),dyspepsia(25%)
anddiarrhoea(25%).Colonictransitwasdelayedin63%ofpatientswithconstipation,whichwassignificantly
(P=0.005)higherthanthatinpatientswithdyspepsia.Delayedcolonictransitwasalsoseenin43%ofpatients
withdiarrhoea.Only26%ofpatientswithconstipationhadadelayinliquidgastricemptyingandsmallbowel
transit.Gastricemptying,smallboweltransitandcolonictransitwerenormalin43,79and29%ofpatientswith
dyspepsia,respectively.Therewasnostaticallysignificantdifferenceingastricemptyingandsmallbowel
transitbetweenpatientswithconstipation,diarrhoeaanddyspepsia.CONCLUSION:Liquidphasewholegut
transitscintigraphyseemstobeausefulinvestigationinpatientswithchronicgastrointestinalsymptoms.
Rationaluseofthismodalitymayhelptheclinicianchangethemanagementorbettercharacterizethe
underlyingproblem/diagnosisinthemajorityofpatientswithfunctionalsymptoms.
*****************************************************************************
PrzeglLek.2009;66(8):4137.
Gastricemptyinginpatientswithgastroesophagealrefluxdiseaseand
postprandialdistresssyndromepreliminaryresults.
Dobrek,NowakowskiM,SyguaA,ThorPJ.
DepartmentofPathophysiology,JagiellonianUniveristy,MedicalCollege,Cracow,Poland.lukaszd@mp.pl
BACKGROUND:GastricmotordisturbancesareobservedinpatientswithbothGastroesophagealRefluxDisease
(GERD)formswith(ERD)andwithout(NERD)esophagealinflammatorychanges,andinFunctionalDyspepsia
(FD)patients,particularlyinthosewithPostprandialDistressSyndrome(PDS).GastricHelicobacterpylori(Hp)
infectionisoftenpresentintheseentities.WetriedtoevaluateifthereisanyinfluenceofHpongastric
emptying(GE)inrefluxanddyspepticpatients.MATERIALANDMETHODS:25GERDpatientsaged45.7+/13.1
yrs(10NERD;5Hp+and5Hpand15ERDwithgradeAesophagitisaccordingtoLosAngelesclassification;5
Hp+and10Hp)and15PDSpatients(5Hp+and10Hp)aged47.9+/14.0yrsparticipatedinourstudy.All
patientsunderwentuppergastrointestinaltractendoscopy,Hpstatusverification,stationaryesopageal
manometry,24hourambulatorypHmetryandgastricscintigraphywithaliquidtestmeal.RESULTS:In
general,bothGERDgroupsandPDSpatientshadprolongedGE(T1/2NERD54.9+/6.3[min],ERD41.7+/
14.8[min]andPDS54.3+/24.8[min]vs.35.2+/13.9[min]incontrol;p<0,05).AccordingtoHpinfection,we
foundinbothNERDandPDSgroupsprolongedGEinHp+subjectsincomparisontoHpones(respectively:T
1/266.5+/21.2[min]vs.43.8+/11.4[min]inNERD;p<0.05;63.5+/29.0[min]vs.48.0+/27.7[min]in
PDS;p<0.05).ThesedifferenceswerelesspronouncedinERDsubjects:44.5+/17.7[min]Hp+vs.37.4+/15.2
[min]inHpERD;p>0.05).CONCLUSIONS:BothNERDandPDSpatientshadmoredecreasedGEhalftime
comparedtothosewithinflammatoryesophagealchanges.Inparticulargroups,Hpinfectionwasassociated
withslowerGErateandelongatedT1/2inNERDandPDSgroupbutwithnoeffectinERDpatients.
*****************************************************************************
AnnNuclMed.2009Nov;23(9):7716.Epub2009Oct24.
Esophagealtransitscintigraphyandstructuredquestionnaireinpatients
withsystemicsclerosiswithendoscopicallyprovenrefluxesophagitis.
NakajimaK,InakiA,HiramatsuT,HasegawaM,FujimotoM,TakeharaK,KinuyaS.
DepartmentofNuclearMedicine,KanazawaUniversityHospital,Kanazawa,Japan.nakajima@med.kanazawa
u.ac.jp
OBJECTIVES:Esophagealcomplicationsarecommoninpatientswithsystemicsclerosis(SSc).Therelationship
betweengastroesophagealreflux(GER)symptomsanddysmotilitywasexaminedinendoscopicallyconfirmed
patientssuspectedofhavingrefluxesophagitis.METHODS:Atotalof32patientswithlimitedanddiffusetype
SSc(lSSc,dSSc)wereexaminedbasedonastructuredquestionnairescore(QS)ofGERsymptoms,retention
fractionofesophagealscintigraphyat90s(R(90))andgastricemptyingtime.RESULTS:TheQSwas
significantlyhigherintherefluxesophagitisgroupthaninthenonesophagitisgroup(5.4+/3.5,1.4+/2.9,P=
0.003).WhenthenonesophagitisgroupwasfurtherdividedintolSScanddSScgroups,R(90)washigherinthe
refluxesophagitisgroup(31+/18%)andthenonesophagitisgroupwithdSSc(34+/32%)thaninthenon
esophagitisgroupwithlSSc(8+/3%,P=0.02).BothhighR(90)>or=15%andQS>or=4indicatedreflux
esophagitis.Conversely,bothnormalR(90)andQSindicatednorefluxesophagitis.CONCLUSION:Acombination
ofesophagealscintigraphyandstructuredquestionnairedemonstrateddifferentaspectsofesophageal
dysfunction,namelydysmotilityandGER.PatientswithhighQSanddysmotilitymaybeindicatedforfurther
evaluationincludingendoscopicexaminationandmedicaltreatment.
*****************************************************************************
AnnNuclMed.2009Nov;23(9):8135.Epub2009Sep29.
UtilityofSPECT/CTwithMeckel'sscintigraphy.
DillmanJR,WongKK,BrownRK,FreyKA,StrousePJ.
DepartmentofRadiology,CSMottChildren'sHospital,UniversityofMichiganHealthSystem,AnnArbor,MI
48109,USA.
Meckel'sdiverticulumisarelativelycommonsourceofgastrointestinaltractmorbidityinchildren.Individuals
maypresentwithsymptomsoflowergastrointestinaltractbleeding,bowelobstructionordiverticulitis.
Technetium99mpertechnetatescintigraphyisusedtodemonstratethoseMeckel'sdiverticulathatcontain
heterotopicgastricmucosa.Wepresentacaseofanadolescentmalepatientwithrectalbleedingandsuspected
Meckel'sdiverticulumwheretheuseofSPECT/CTfusionimagingprovidedvaluablediagnosticinformationand
preventedafalsenegativestudy.
PMID:19784878[PubMedinprocess

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