Presentation
45-year-old man with a history of diabetes. Postprandial pain.
Patient Data
Anterior and posterior planar images of the abdomen obtained at 0 minutes (immediately after meal ingestion), 30 minutes, 1-hour, 2-hours and 4-hours. Region-of-interest (ROI) delineates the stomach. The counts are measured and used to calculate the geometric mean and the percent retention at each time point.
At T=0, immediately after meal consumption, the radiolabeled meal appropriately localizes to the fundus due to fundal accommodation. It subsequently rapidly progresses distally with increased transit into the small bowel at 30-minutes and 1-hour; representing rapid gastric emptying.
By 4-hours, a large amount of the meal is in the transverse colon.
Case Discussion
Gastric emptying scintigraphy is a physiologic means of evaluating gastric transit, providing both qualitative and quantitative data.
Rapid gastric emptying, as seen in this case, is defined as <70% retention at 30-minutes and/or <30% retention at 1-hour. These values are based upon a standardized solid meal, patient preparation and imaging protocol established by a multidisciplinary panel of gastroenterologists and nuclear medicine physicians in 2008.
While delayed gastric emptying is a typical finding in individuals with longstanding diabetes, rapid gastric emptying is now a recognized complication, often preceding gastroparesis.