不同显像方位测定胃排空的比较研究

放射性核素显像法测定胃排空时间被认为是定量分析胃排空的“金标准”［１］。目前常采用前位显像法测定胃排空，而文献报道前位和后位同时采集取几何均值（ＧＭ）或左前斜位显像明显优于单纯前位法［２，３］。为选择一种既简便又比较准确的显像方位，笔者比较了２３例患...     

放射性核素胃排空显像

放射性胃排空显像具有方法简便、无创伤、可重复、符合生理状况、可精确定位等优点,它对消化道疾病病因学探讨和胃肠道功能研究具有重要的临床价值,是测定胃排空的金标准。本文结合临床工作经验和文献复习,对放射性核素胃排空测定方法、标记试餐标准化、胃感光趣区的确定及常见影响因素等新技术、新观点加以评述。     

放射性核素胃排空显像

放射性胃排空显像具有方法简便、无创伤、可重复、符合生理状况、可精确定位等优点,它对消化道疾病病因学探讨和胃肠道功能研究具有重要的临床价值,是测定胃排空的金标准。本文结合临床工作经验和文献复习,对放射性核素胃排空测定方法、标记试餐标准化、胃感兴趣区的确定及常见影响因素等新技术、新观点加以评述。     

胃排空动态显像中双核素标准餐的应用

目的研究１３１Ｉ小牛血清白蛋白（ＢＳＡ）和９９ｍＴｃＤＴＰＡ双核素胃排空动态显像的方法及探讨其临床应用价值。方法用前临时标记１３１ＩＢＳＡ和９９ｍＴｃＤＴＰＡ，配成１３１ＩＢＳＡ鸡蛋固体餐和９９ｍＴｃＤＴＰＡ水液体餐。固体餐经人胃液消化试验，检测标记物稳定性。检查３５例慢性胃炎病人和１０例健康志愿者的胃排空功能，其中２例在３天内进行了１３１ＩＢＳＡ鸡蛋餐和９９ｍＴｃ硫胶体（Ｓｃ）鸡肝餐两法对照，比较其相关性。结果１３１ＩＢＳＡ和９９ｍＴｃＳｃ在胃液中消化２小时，脱标率分别为３００％和５１６％；１３１ＩＢＳＡ鸡蛋餐法和９９ｍＴｃＳｃ鸡肝餐法相关性好，ｒ＝０９８９，Ｐ＜００１；对照组固相半排空时间（ＨＳＥＴ）为５８２±１７７分钟，液相半排空时间（ＨＬＥＴ）为２３５±９４分钟；病例组ＨＳＥＴ为９２５±２９６分钟，ＨＬＥＴ为３７２±１６６分钟；固相和液相两组差异均有显著性（ｔ＝３４７４和２４８５，Ｐ＜００１）。结论１３１ＩＢＳＡ鸡蛋餐、９９ｍＴｃＤＴＰＡ液体餐同时使用（双核素标准餐法）可为临床提供胃排空固体和液体食物的情况     

核素胃排空在近端胃手术中的实验研究

目的：探讨近端胃手术不同术式后胃排空功能的改变,应用ＳＰＥＣＴ液体胃排空方法测定胃半排时间（ＧＥｔ１／２）,方法：４０只大白鼠分成４组,每组均行选择性迷走神经干切断术,Ａ组未另附加其它要式,Ｂ组附加幽门成形,Ｃ组行近端胃切除,Ｄ组行近端胃切除附加幽门成形,术前及术后１,２,３周分别行核素胃排空显像测定ＧＥｔ１／２。     

胃食管反流病的胃排空功能研究

目的　探讨胃食管反流病 (GERD)胃液体、固体排空情况及与pH值监测结果的相关性。方法　 15例GERD患者分别进行胃镜检查、2 4h食管pH值监测和放射性核素胃排空功能测定 ,与对照组液体和固体胃排空率、胃半排空时间进行比较 ,分析GERD患者液体、固体排空率与食管炎及 2 4hpH值监测指标之间的关系。结果　GERD组液体胃排空率在 15、30min明显低于对照组 (P<0 0 5 ) ,固体胃排空率在各时间点均低于对照组 (P <0 0 5 )。GERD患者液体半排空时间与pH值监测总积分无相关性 (r=0 0 6 1,P >0 0 5 ) ;固体半排空时间与pH值监测总积分呈直线相关 (r=0 6 43,P <0 0 5 )。结论　GERD患者存在胃液体、固体排空延迟。固体半排空时间与pH值总积分呈直线相关。胃排空延迟可能是GERD发病机制的重要因素。     

研究功能性消化不良患者胃排空功能改变的高危因素

目的：对功能性消化不良病人胃排空功能的异常与症状之间的关系进行探讨及运用西沙比利药物的疗效进行研究。方法选取医治的功能性消化不良病人36例，并对其疾病的4种症状进行分级，并进行胃排空检查，并与14例健康人对照组比较，通过对36例功能性消化不良病人给予西沙比利5 mg，日三次口服治疗后效果做自身对照比较。结果治疗前实验组固体半排时间为58 min ±11 min，对照组（健康人）为49 min ±12 min （ P＜0.05），治疗后为50 min ±10 min（ P＜0.05）；液体半排时间分别为11 min ±6 min，对照组（健康人）为13 min ±8 min（ P＞0.05），治疗后为11 min ±5 min，与治疗前比较具有统计学意义（ P＞0.05）。腹痛、腹胀、恶心、呕吐与固体胃排空延迟的回归系数分别为0.542，0.380、0.177，0.462。结论功能性消化不良病人可导致固体胃排空迟缓，西沙比利具有促进胃排空作用，固体胃排空的危险因素由腹胀、腹痛、呕吐导致。     

胃食管反应流的胃排空功能研究

目的探讨胃食管反流病（ＧＦＲＤ）胃液体、固体排空情况与ＰＨ值监测结果的相关性。方法１５例ＧＥＲＤ患分别进行胃镜检查、２４ｈ食管Ｐ 和放射性核素胃排空功能测定，与对照组液体和固体胃排空率、胃半排空时间进行比较，分析ＧＥＲＤ患液体，固体排空率与食管炎及２４ｈ ｐＨ值监测指标之间的关系。结果ＧＥＲＤ组液体胃排空率在１５、３０ｍｉｎ明显低于对照组（Ｐ〈０．０５），固体胃排空率在各时间点均低于对照组（Ｐ     

利尿后18F-FDG PET/CT延迟显像对前列腺癌的临床诊断价值

目的 探讨利尿后18F-氟脱氧葡萄糖（FDG） PET/CT延迟显像对前列腺癌（PCa）的临床诊断价值和最佳延迟显像时间。 方法 回顾性分析2009年3月至2018年12月于武装警察部队特色医学中心行18F-FDG PET/CT全身显像显示前列腺病变的235例男性患者的临床资料,其中前列腺恶性病变患者77例、前列腺良性病变患者158例,年龄50~87（69.6±13.6）岁。所有患者均行利尿前及利尿后延迟显像（1、2、3、4 h）,获得利尿前、后病灶的最大标准化摄取值（SUV_max）。以利尿后SUV_max>2.5且利尿前、后SUV_max的储留指数>15%作为判断良、恶性的标准。2组间数据的比较采用独立样本t检验。 结果 前列腺恶性病变患者利尿后延迟1、2、3 h显像的SUV_max均分别高于利尿前,差异均有统计学意义（5.57±1.58对4.32±1.01、7.04±3.03对4.62±1.84、7.28±2.90对4.73±1.88,t=3.399、3.676、2.660,均P<0.05）;利尿后延迟4 h显像的SUV_max与利尿前相比,差异无统计学意义（t=1.103,P=0.286）。前列腺良性病变患者利尿后延迟1、2、3、4 h显像的SUV_max与利尿前相比,差异均无统计学意义（t=0.268~0.865,均P>0.05）。恶性病变患者利尿后延迟1、2、3 h显像的SUV_max均分别高于良性病变患者（t=2.013、3.910、3.554,均P<0.05）,而2组患者利尿后延迟4 h显像的SUV_max差异无统计学意义（t=1.379,P=0.181）。恶性病变患者利尿后延迟2、3 h比延迟1 h显像的SUV_max高（t=2.220、2.400,均P<0.05）。利尿后18F-FDG PET/CT延迟1、2、3、4 h显像对前列腺癌诊断效能中,延迟2 h显像的特异度[74.5%（38/51）]和准确率[76.3%（61/80）]最高,而延迟3 h显像的灵敏度[84.6%（11/13）]最高。 结论 PCa患者利尿后延迟显像可提高显像效果和临床诊断的效能,利尿后延迟2 h显像的诊断效果较优。     

非溃疡性消化不良的胃运动功能改变

目的：利用试验餐和放射性核素显像研究非溃疡性消化不良（ＮＵＤ）患者的胃运动功能。方法：将９９ｍＴｃ－植酸钠６ＭＢｑ加入黑芝麻糊粉８０ｇ，受试者３分钟内服下，然后以全胃为感兴趣区，行放射性核素显像，得胃排空曲线，计算１５、３０、４５、６０和９０分钟胃排空率。结果：ＮＵＤ患者服试验餐后，６０和９０分钟胃排空率明显低于对照组。以低于正常值ｘ±ｓ为标准，则４９／６０例ＮＵＤ病人胃排空功能异常。促动力型药物吗丁啉和Ｈ受体阻滞剂雷尼替了对治疗ＮＵＤ的效果无明显差异，而吗丁啉对胃排空率降低者的疗效优于胃排空率正常者。结论：用自然餐进行胃排空研究能较好反映胃的功能，对ＮＵＤ的治疗有一定指导意义。     

Anterior,posterior, left anterior oblique,and geometric mean views in gastric emptying studies using a glucose solution

Previous research has shown that the single anterior view of the stomach overestimates the gastric half-emptying time of a solid meal compared to the geometric mean of the anterior and posterior views. Little research has been performed comparing the various views of gastric emptying of a glucose solution. After an overnight fast, 49 nondiabetic subjects were given a 450 ml solution containing 50 g of glucose and 200 Ci of technetium-99m sulfur colloid. Sequential 1-min anterior, posterior, and left anterior oblique views were obtained every 15 min. The mean percent solution remaining in the stomach for all three views differed from the geometric mean by 1.9% or less at all time points. Average gastric half-emptying times were: geometric mean, 62.7±3.3 min; anterior, 61.9±3.2 min; posterior, 63.5±3.5 min; and left anterior oblique, 61.6±3.3 min. These half-emptying times were not statistically different. For individual patients, differences between all three views and the geometric mean were not clinically important. Approximately 95% of all patients are expected to have gastric half-emptying times measured by any of the three single views within 17 min of the gastric half-emptying time obtained using the geometric mean. The imaging of gastric emptying using glucose solutions can be performed using a convenient single view which allows continuous dynamic imaging.     

Evaluation of reproducibility of solid-phase gastric emptying in healthy subjects

Radionuclide gastric emptying studies are performed as a matter of clinical routine. Our aim was to evaluate the inter- and intea-individual variability and the reproducibility of gastric emptying studies in healthy young male volunteers using a single solid-phase, standard meal. The meal consisted of a pancake (500 KJ) tagged with technetium 99m sulphur colloid and no additional liquid. Continuous acquisitions of gastric activity in anterior projection were taken during 90 min, starting from the onset of the meal. Gastric emptying was evaluated three times in a 3-week period. Five different parameters were evaluated. Our results show that there is important inter- and intea-individual variability in normal volunteers. In spite of this variability, no significant difference between the different series of gastric emptying studies was observed.This work was performed at the Department of Nuclear Medicine, A.Z. Middelheim, Antwerp, Belgium     

非溃疡性消化不良飞行员胃运动功能的改变

目的　对患有非溃疡性消化不良的飞行人员进行胃排空功能检测。　方法　采用双核素标记试餐及单光子发射计算机体层摄影 (SPECT)技术 ,对 5 4例非溃疡性消化不良 (NUD)飞行员(其中包括类溃疡型 2 3例 ,运动障碍型 2 6例 ,返流型 5例 )和 6 4例健康飞行员进行胃排空测定 ,求出各自全胃半排空时间 (T1 /2 ) ,近端胃半排空时间 (PT1 /2 ) ,固体食物开始排空前的延迟时间 (T1 )及其异常的发生率。　结果　与对照组相比 ,NU D组飞行员液体 T1 /2 延长 ,与 3型 NU D间均无明显关系 ;固体 T1 /2 明显延长 ,异常发生率 72 .2 % ,与运动障碍型 NUD和返流型 NU D呈正相关 (r=0 .81和 0 .78,P<0 .0 5 ) ;PT1 /2 与类溃疡型 NUD呈正相关 (r=0 .75 ,P<0 .0 5 ) ;T1 异常发生率 88.9% ,其中38.2 %延迟 ,与运动障碍型 NU D呈正相关 (r=0 .78,P<0 .0 5 ) ,另 6 1.8% T1 消失 ,与类溃疡型 NU D呈负相关 (r=- 0 .6 7,P<0 .0 5 )。　结论　 NUD飞行员多有固体食物排空障碍。     

A simple scintigraphic method for continuous monitoring of gastric emptying

A new and simple scintigraphic method for the measurement of gastric emptying was developed and validated. The test meal consists of 200 g potato mash mixed with 0.5 g Dowex 2X8 particles (mesh 20–50) labelled with 37 MBq (1 mCi) technetium-99m. After ingestion of the meal, sequential dynamic 15-s anteroposterior exposures in the supine position are obtained for 90 min. A second recording sequence of 20 min is added after a 30-min interval. The results can be displayed as immediate cine-replay, as time-activity diagrams and/or as activity retention values. Complicated mathematical fittings are not necessary. The method lends itself equally to the testing of in- and outpatients. Correspondence to: R.W Lipp     

Evaluation of small-bowel transit for solid and liquid test meal in healthy men and women

Evaluation of severe functional gastrointestinal motility disorders requires an investigation of the entire gastrointestinal tract. This should be possible with a single radionuclide imaging study. The purpose of this study was (1) to define normal values of small-bowel transit in men and women and (2) to assess a possible difference between gender or test meal, since it has been shown that women have slower gastric emptying than men, and gastric emptying of solids is slower than liquids. A standard gastric-emptying test for a solid (technetium-99m sulphur colloid, 230 Kcal) and liquid (indium-111 DTPA water) test meal was performed in 12 healthy male and 12 healthy female volunteers. After 135 min, the volunteer was placed in the supine position for static imaging of the abdomen every 15 min for 6 h. Decay and crossover-corrected geometric mean gastric-emptying data were fit to a modified power exponential function to determine the 10% stomach emptying time for solids and liquids separately. An ROI was drawn around the caecum and ascending colon to determine the arrival time of at least 10% of the solid and liquid test meal. Ten percent small-bowel transit time (10%SBTT) and orocaecal transit time (OCTT) were calculated.The OCTT for males and females, respectively for solids and liquids, are 294.6±18.8; 301.3±24.5; 294.6±18.8 and 301.3±24.5 min. The 10%SBTT for males and females, respectively for solids and liquids, are 280.3±18.4; 280.6±24.0; 288.2±18.9 and 297.4±24.4 (mean±SEM) min. We observed a simultaneous transfer of solids and liquids from the terminal ileum to caecum (correlation coefficient 0.90). There is no statistically significant difference in SBTT between gender or solids and liquids. In contrast to the gastric-emptying time, the SBTT of solids and liquids were not significantly different nor was a gender difference found. Determination of the OCTT seems to be the simplest and most accurate approach to measure SBTT. Since ileocaecal transfer occurs as a bolus phenomenon, a ¹¹¹In-labelled test meal can also be used for the determination of colon transit in a single imaging study protocol. Received: 24 May and in revised from 1 July 1999     

Comparison of total and compartmental gastric emptying and antral motility between healthy men and women

There is increasing evidence of gender-related differences in gastric emptying. The purpose of this study was first, to confirm the difference in gastric emptying for both solid and liquid test meals between healthy men and women, and secondly, to investigate the origin of this difference by studying regional gastric emptying and antral motility. A standard gastric emptying test with additional compartmental (proximal and distal) evaluation and dynamic imaging of the antrum was performed in 20 healthy women studied during the first 10 days of the menstrual cycle, and in 31 healthy age-matched men. In concordance with previous reports, women had a longer half-emptying time for solids as compared to men (86.2±5.1 vs 52.2±2.9 min, P<0.05). In our observations this seemed to be related to a significantly prolonged lag phase and a significant decrease in terminal slope. Dynamical antral scintigraphy did not show a significant difference. The distribution of the test meal within the stomach (proximal vs distal) showed more early proximal retention in women as compared to men. The terminal slope of the distal somach was significantly lower in women. We did not observe a significant difference in gastric emptying of the liquid test meal between men and women. Gastric emptying of solids is significantly slower in healthy women as compared to men. These findings emphasise the importance of using different normal values for clinical and research purposes in gastric emptying scintigraphy in men and women. The difference could not be explained by antral motility alone. Increased proximal retention and a lower terminal emptying rate in women are observations to be further investigated. Received 2 February and in revised form 17 April 1998     

Influence of the menstrual cycle and of menopause on the gastric emptying rate of solids in female volunteers

The aim of this study was to assess the influence of the normal menstrual cycle and of menopause on the gastric emptying rate of solids. Gastric emptying was studied in 15 premenopausal and ten postmenopausal women with an isotopic technique after the ingestion of a radiolabelled test meal. Premenopausal women were studied twice: within 1 week prior to menses and again 1 week after onset of menses. Postmenopausal women were studied only once. The emptying curves of the solid component of the meal fitted a linear model. The half-emptying time was 78±5 min during the follicular phase, 75 ± 7 min during the luteal phase and 76 ± 6 min in post-menopausal women (differences not statistically significant). The mean percentages of the meal retained in the stomach at different time intervals were also similar in the three groups. These results suggest that the menstrual cycle does not influence the gastric emptying rate of solids, which remains unchanged in relation to the follicular phase or after menopause. Correspondence to: I. Carrió     

Comparison of left anterior oblique, anterior and geometric mean methods for determining gastric emptying times.

The accurate determination of gastric emptying time requires correction or compensation for tissue attenuation. The gold standard for tissue attenuation correction for gastric emptying is the geometric mean of the gastric counts from the anterior and posterior views. For reasons of efficiency, many community hospitals acquire only the anterior projection. This study addressed the hypothesis that, using the left anterior oblique view alone, one can minimize the effect of variation in attenuation as the meal moves from the fundus to the stomach to the more anterior antrum to a degree equal to that of the geometric mean technique. We studied 42 consecutive patients using a standardized 300-g meal labeled with 650 muCi of 99mTc-sulfur colloid. The patients were imaged in the anterior (ANT), posterior (POST) and left anterior oblique (LAO) views every 15 min for 90 min. Linear regressions were obtained using the ANT, LAO and GM data. Cross-correlation of the T1/2 for 35 cases showed an R value for the GM versus LAO of 0.95 and GM versus ANT of 0.84. The p value greater than 0.49, for the paired two-tailed t-test of the LAO and GM methods. The p value for the ANT and GM methods is 0.0058 indicating a significant difference between these methods. The cross-correlation, F-test p and t-test p values support the hypothesis that there is no significant difference between the geometric mean and left anterior oblique gastric emptying times. It is therefore reasonable to substitute the left anterior oblique for routine GET when using a solid meal in patients with normal gastric anatomy, albeit altered physiology.     

甲亢患者治疗前后血浆胃动素和食管、胃液体食物排空功能的变化

检查了甲亢患者常规药物治疗前后以及正常对照者血浆胃动素、血清甲状腺激素和食管、胃液体食物排空功能及其他们之间的相互关系。结果发现,甲亢患者治疗前胃动素水平增高,胃液体食物排空功能增强,治疗后均恢复正常。血浆胃动素水平与胃液体食物半排空时间之间相关性不明显(r=-0.2833,P>0.05),与血清T_3水平之间呈一定的正相关(r=0.4802,P<0.01),血清T_3水平与胃液体食物半排空时间之间呈一定的负相关(r=-0.4586,P<0.01)。