Assessment of Gastric Accommodation in Patients with Functional Dyspepsia by 99mTc-Pertechtenate Single Photon Emission Computed Tomography Imaging: Practical but not Widely Accepted

Objective: Impaired gastric accommodation is one of the main symptoms in patients with functional dyspepsia. The aim of the present study was to assess gastric accommodation in patients with functional dyspepsia using single photon emission computed tomography (SPECT) imaging. Methods: Twenty-four patients with functional dyspepsia and 50 healthy volunteers as control group were enrolled in this study. All participants were given 5 mCi 99mTc-pertechtenate intravenously, served with a low fat meal, and underwent SPECT scanning 20 minutes after the meal. Results: Based on the scintigraphic data, gastric volumes were found to be significantly increased after food ingestion in both patient and control groups. We also found that while there was no significant difference between patient and control groups in terms of fasting gastric volumes, postprandial gastric volume was significantly lower in patients as compared to healthy individuals (p<0.05). Conclusion: Measuring gastric volume by using SPECT can be a valuable method in the detection of functional dyspepsia and in differentiation of this entity from other organic disorders

The association of increased stomach wall radiotracer uptake with prolonged use of Omeprazole capsules on myocardial perfusion imaging (MPI) using 99mTc-sestamibi SPECT

Myocardial perfusion imaging (MPI) is widely used in routinepractice for diagnosis and risk stratification of coronary arterydisease (CAD). Intense curvilinear activity in the stomach wallof a patient was seen on MPI raw data. This phenomenon was completely dissimilar to the familiar intraluminal gastricreflux of sestamibi. This observed activity could have resultedin false-positive or false-negative artifacts — and inaccurate diagnosis — of the inferior wall of the left ventricle after MPI processing. On further exploration, the current researchers found that the patient had a history of 10-year Omeprazole capsule consumption. The authors present this infrequent case of intense stomach uptake to stress the related clinical and diagnostic implications with the aim to stimulate acute awareness of possible, unexpected infringements on image quality that could potentially interfere with accurate interpretation of the data

Assessment of the Prevalence of Diabetic Gastroparesis and Validation of Gastric Emptying Scintigraphy for Diagnosis.

OBJECTIVE: Gastroparesis is defined as delayed gastric emptying and is a common medical condition in diabetic patients. Scintigraphy is commonly used as a standard diagnostic procedure for the quantitative assessment of gastroparesis. The aims of this study were to determine an optimum imaging time for the diagnosis of gastroparesis, to assess the prevalence of gastroparesis, to evaluate the correlation between endoscopy and scintigraphy findings as well as the correlation between gastric emptying with patient genders, blood glucose concentration, and functional dyspepsia. METHODS: Gastric emptying was assessed in 50 diabetic patients with a mean age of 50.16 years. For evaluation of gastric emptying, a test meal containing 2 pieces of toast, 120 cc non-labeled water and fried egg labeled with 1 mCi of 99mTc was given to each patient. The scintigraphy was performed immediately after ingestion and was repeated at 1, 1.5, 2 and 4 hours after ingestion. In some patients, an additional 90-minute dynamic scan was also acquired. RESULTS: The prevalence of gastroparesis in this study population was determined as 64%. Also, the results of this study revealed that a 4-hour scan after ingestion is more relevant than a 90-minute dynamic scan for the evaluation of delayed gastric emptying. There was no statistically significant difference between 1-hour and 2-hour scans, 1-hour and 90-minute scans, 2-hour and 90-minute scans, 2-hour and 4-hour scans. Likewise there was no significant correlation between blood glucose levels, gender and calculated values of gastric emptying time in all groups. CONCLUSION: According to our findings, it can be suggested that the prevalence of gastroparesis is higher than that mentioned in some previous studies. Also, this study indicates that a gastric emptying scintigraphy at 2 and 4 hours after meal ingestion might provide the anticipated clinical information in diabetic patients with dyspepsia without other evident reasons

A case of Mantle Cell Lymphoma with Multiple Lymphomatous Polyposis

Multiple Lymphomatous Polyposis (MLP) is characterized by multiple polyps involving long segments of the GI tract. More than 75% of the cases are derived from pregerminal center B cells (mantle zone B cells) & less than 25% from germinal center B cells. Thus MLP is a heterogenous group that includes Mantle Cell Lymphoma (MCL) & Follicular Lymphoma (FL). Here we present a 75-year-old sailor who referred to us with abdominal pain, bloody diarrhea, iron deficiency anemia & lymphadenopathy in inguinal & femoral regions. The presence of intestinal polyposis in colonoscopic & endoscopic evaluations & the pathologic & immunohistochemical findings on tissue specimens that showed B cell lymphoma with moderate proliferative activity (50%) & nodular proliferation of small lymphocytes accompanied with positivity for CD5, CD20, CD43 & negativity for CD3, CD10, CD23 revealed that these findings are consequent to MCL with accompanied MLP

The association of increased stomach wall radiotracer uptake with prolonged use of Omeprazole capsules on myocardial perfusion imaging (MPI) using 99mTc-sestamibi SPECT

Myocardial perfusion imaging (MPI) is widely used in routine practice for diagnosis and risk stratification of coronary artery disease (CAD). Intense curvilinear activity in the stomach wall of a patient was seen on MPI raw data. This phenomenon was completely dissimilar to the familiar intraluminal gastric reflux of sestamibi. This observed activity could have resulted in false-positive or false-negative artifacts — and inaccurate diagnosis — of the inferior wall of the left ventricle after MPI processing. On further exploration, the current researchers found Myocardial perfusion imaging (MPI) with exercise or pharmacological stress, either with thallium-201 (201Tl) or technetium-99m (99mTc)-sestamibi, is widely used for preparation of diagnostic and prognostic information regarding patients with proved or possible coronary artery disease (CAD) and it facilitates the accurate management of CAD patients [1]. However, with present myocardial radiotracers, such as 99mTc-sestamibi, rather high extra-cardiac activity is usually seen, which is mostly associated with physiologic hepatobiliary or renal excretion [2]. In contrast, there are limited reports suggesting possible non-physiologic reasons for these visceral uptakes, and occasionally, indicating different underlying pathologies [2]. Indeed, accidental pathological fi ndings during myocardial perfusion imaging are not scarce and cautious examination of the full fi eld of image acquisition has been useful in identifying these accidental fi ndings [3–5]. Alternatively, most efforts concentrate on dissolving these interfering abdominal activities without attention to the clinical importance of such fi ndings [6, 7]. On the MPI raw data of one such patient, intense curvilinear activity in the stomach wall was evident. This phenomenon was completely dissimilar to the familiar intraluminal gastri