PT  - JOURNAL ARTICLE
AU  - Perry Orthey
AU  - Daohai Yu
AU  - Mark L. Van Natta
AU  - Frederick V. Ramsey
AU  - Jesus R. Diaz
AU  - Paige A. Bennett
AU  - Andrei H. Iagaru
AU  - Roberto Salas Fragomeni
AU  - Richard W. McCallum
AU  - Irene Sarosiek
AU  - William L. Hasler
AU  - Gianrico Farrugia
AU  - Madhusudan Grover
AU  - Kenneth L. Koch
AU  - Linda Nguyen
AU  - William J. Snape
AU  - Thomas L. Abell
AU  - Pankaj J. Pasricha
AU  - James Tonascia
AU  - Frank Hamilton
AU  - Henry P. Parkman
AU  - Alan H. Maurer
TI  - Intragastric Meal Distribution During Gastric Emptying Scintigraphy for Assessment of Fundic Accommodation: Correlation with Symptoms of Gastroparesis
AID  - 10.2967/jnumed.117.197053
DP  - 2018 Apr 01
TA  - Journal of Nuclear Medicine
PG  - 691--697
VI  - 59
IP  - 4
4099  - http://jnm.snmjournals.org/content/59/4/691.short
4100  - http://jnm.snmjournals.org/content/59/4/691.full
SO  - J Nucl Med2018 Apr 01; 59
AB  - Impaired fundic accommodation (FA) limits fundic relaxation and the ability to act as a reservoir for food. Assessing intragastric meal distribution (IMD) during gastric emptying scintigraphy (GES) allows for a simple measure of FA. The 3 goals of this study were to evaluate trained readers’ (nuclear medicine and radiology physicians) visual assessments of FA from solid-meal GES; develop software to quantify GES IMD; and correlate symptoms of gastroparesis with IMD and gastric emptying. Methods: After training to achieve a consensus interpretation of GES FA, 4 readers interpreted FA in 148 GES studies from normal volunteers and patients. Mixture distribution and κ-agreement analyses were used to assess reader consistency and agreement of scoring of FA. Semiautomated software was used to quantify IMD (ratio of gastric counts in the proximal stomach to those in the total stomach) at 0, 1, 2, 3, and 4 h after ingestion of a meal. Receiver-operating-characteristic analysis was performed to optimize the diagnosis of abnormal IMD at 0 min (IMD0) with impaired FA. IMD0, GES, water load testing, and symptoms were then compared in 177 patients with symptoms of gastroparesis. Results: Reader pairwise weighted κ-values for the visual assessment of FA averaged 0.43 (moderate agreement) for normal FA versus impaired FA. Readers achieved 84.0% consensus and 85.8% reproducibility in assessing impaired FA. IMD0 based on the division of the stomach into proximal and distal halves averaged 0.809 (SD, 0.083) for normal FA and 0.447 (SD, 0.132) (P < 0.01) for impaired FA. On the basis of receiver-operating-characteristic analysis, the optimal cutoff for IMD0 discrimination of normal FA from impaired FA was 0.568 (sensitivity, 86.7%; specificity, 91.7%). Of 177 patients with symptoms of gastroparesis, 129 (72.9%) had delayed gastric emptying; 25 (14.1%) had abnormal IMD0. Low IMD0 (impaired FA) was associated with increased early satiety (P = 0.02). Conclusion: FA can be assessed visually during routine GES with moderate agreement and high reader consistency. Visual and quantitative assessments of FA during GES can yield additional information on gastric motility to help explain patients’ symptoms.