title: Comprehensive radionuclide esophagogastrointestinal transit study: methodology, reference values, and initial clinical experience.
abstract: A radionuclide methodology and reference values have been developed for a single gastrointestinal transit study including esophageal transit, liquid and solid gastric emptying, and small- and large-bowel transit, using (111)In-diethylenetriaminepentaacetic acid (DTPA) with the standardized (99m)Tc-labeled solid meal.
  
  
  METHODS
  Eighteen healthy subjects and 18 patients were investigated. The esophageal transit study was performed with 3.7 MBq (0.1 mCi) of (111)In-DTPA in 15 mL of water. A liquid-only 30-min gastric-emptying study followed, with ingestion of 3.7 MBq (0.1 mCi) of (111)In-DTPA in 300 mL of water. Then, a simultaneous solid-liquid emptying study was acquired after ingestion of a solid (99m)Tc-sulfur colloid-labeled meal and 7.4 MBq (0.2 mCi) of (111)In-DTPA in 120 mL of water. Images were acquired intermittently for 4 h. Additional (111)In images were acquired at 5 and 6 h to measure small-bowel transit, and at 24, 48, and 72 h for large-bowel transit.
  
  
  RESULTS
  Reference values were determined for esophageal transit (transit time, percentage emptying at 10 s), liquid-only gastric emptying (emptying half-time), liquid and solid emptying in a dual-phase solid-liquid study (emptying half-time and percentage emptying at 1, 2, 3, and 4 h), small-bowel transit index (percentage transit to ileocecal valve at 6 h), and colonic transit (geometric center and percentage colonic emptying) at 24, 48, and 72 h. Results from the first 18 patients found abnormal transit in 72% (13/18); clinical management changed in 61% (11/18).
  
  
  CONCLUSIONS
  We have developed a radionuclide methodology and derived reference values for a comprehensive gastrointestinal transit study using (111)In-DTPA with the standardized (99m)Tc-labeled solid meal. Our initial clinical experience suggests clinical value.
authors.affiliation: Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences; and.
authors.forename: Alexander J
authors.initials: AJ
authors.lastname: Antoniou
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Shreya
authors.initials: S
authors.lastname: Raja
authors.affiliation: Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences; and.
authors.forename: Riham
authors.initials: R
authors.lastname: El-Khouli
authors.affiliation: Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences; and.
authors.forename: Esther
authors.initials: E
authors.lastname: Mena
authors.affiliation: Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences; and.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Lodge
authors.affiliation: Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences; and.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Wahl
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: John O
authors.initials: JO
authors.lastname: Clarke
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Pasricha
authors.affiliation: Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences; and hziessm1@jhmi.edu.
authors.forename: Harvey A
authors.initials: HA
authors.lastname: Ziessman
mesh_terms: D000328:Adult; D000368:Aged; D003938:Diagnostic Techniques, Digestive System / Q000592:standards*; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000502:physiology*; D005260:Female; D005746:Gastric Emptying; D005772:Gastrointestinal Transit; D006801:Humans; D007420:Intestine, Large / Q000000981:diagnostic imaging / Q000502:physiology; D007421:Intestine, Small / Q000000981:diagnostic imaging / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012016:Reference Values; D016284:Technetium Tc 99m Pentetate; D055815:Young Adult
chemical_list: D016284:Technetium Tc 99m Pentetate
keywords: esophageal scintigraphy; gastric emptying; gastrointestinal scintigraphy; intestinal transit