Letter from the Editors: Functional Studies of the Gastrointestinal Tract

Freeman, Leonard M.; Blaufox, M. Donald

doi:10.1053/j.semnuclmed.2011.11.005

Next »Seminars in Nuclear Medicine
Volume 42, Issue 2 , Page 73, March 2012

Letter from the Editors: Functional Studies of the Gastrointestinal Tract

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As pointed out by Dr. Alan Maurer in his guest editorial, it has been more than 15 years since he guest edited another Seminars issue, a two-part review of gastrointestinal (GI) nuclear imaging.¹, ² A significant portion of the progress that has been made relates to attempted standardization of several of these studies. In particular, cooperative efforts between GI, radiology, and nuclear medicine societies have resulted in standardized methodology for gastric emptying studies. Whereas, half-time of emptying (T_1/2) was previously considered the accepted key value or “gold standard,” current thoughts center more on the retention values at specific time intervals; particularly four hours post-ingestion of a labeled solid egg meal. Additionally, several alternative test meals yielding similar endpoints have now been proposed. These areas of progress are highlighted in the articles by Maurer³ and Knight.⁴ Enhanced recognition of the different roles played by the gastric fundus, antrum, and pylorus are also described by Dr. Maurer in both his guest editorial⁵ and article.³

The diagnosis of biliary dyskinesia remains somewhat elusive. For definitive diagnosis of gallbladder disease, gastroenterologists and surgeons generally prefer the anatomic demonstration of gallstones, sludge, and a thickened gallbladder wall provided by sonographic or computed tomography evaluation. However, during the past two decades, there has been increasing interest and acceptance of functional assessment with CCK-enhanced hepatobiliary scintigraphy. Definitive evidence of a reduced gallbladder ejection fraction with or without subjective symptoms has become fairly routine in assessing patients with unexplained right upper quadrant pain and negative anatomic imaging studies. Positive findings in these patients provide sufficient grounds for cholecystectomy. This has resulted in a cure in the vast majority of patients. Dr. Harvey Ziessman has been a leader in efforts to standardize the methodology developed to obtain credible results. He shares his thoughts with us in a related article.⁶

In the following guest editorial, Dr. Maurer describes the contents of the other informative articles in this seminar. He has done a superb job in assembling a stellar cast of authors that has provided us with this most interesting and valuable update on what Nuclear Medicine can achieve in its functional evaluation of the GI tract.

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References

Maurer AH Gastrointestinal Nuclear Imaging: Part I, Functional Studies . Semin Nucl Med . 1995;25:287–364

Maurer AH Gastrointestinal Nuclear Imaging: Part II . Semin Nucl Med . 1996;26:1–74

Maurer AH . Advancing gastric emptying studies: standardization and new parameters to assess gastric motility and function . Semin Nucl Med . 2012;42:101–112

Knight LC . Update on GI radiopharmaceuticals and dosimetry estimates . Semin Nucl Med . 2012;42:138–144

Maurer AH . Guest editorial: gastrointestinal nuclear medicine: Are we making progress? . Semin Nucl Med . 2012;42:74–75

Ziessman HA . Sincalide cholescintigraphy–32 years later (Evidence-based data on its clinical utility and infusion methodology) . Semin Nucl Med . 2012;42:79–83