Review ArticleContinuing Education

Gastrointestinal Motility, Part 2: Small-Bowel and Colon Transit

Alan H. Maurer
Journal of Nuclear Medicine Technology March 2016, 44 (1) 12-18; DOI: https://doi.org/10.2967/jnumed.113.134551

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Sequential gastric emptying images showing normal small-bowel transit after liquid 111In-DTPA meal (anterior views). Early diffuse small-bowel activity later progressively accumulates in terminal ileum reservoir (oval region of interest). More than 60% of total activity is already in terminal ileum by 4 h (240 min), followed by further progression into cecum–ascending colon (arrow) at 6 h (300 min) and then progressive filling of ascending colon, with 100% of activity having completed transit through small bowel at 6 h (360 min).

  • FIGURE 2.
    FIGURE 2.

    (A) Demonstration of how location of ileocolonic junction is defined scintigraphically in relationship to terminal ileum and proximal colon (top) and how regions of interest (bottom) have been defined to study coordination of manometric pressure recordings with luminal flow. (B) Serial images illustrating how radiotracer activity in terminal ileum and cecum can be linked to simultaneous pressure recordings. With this technique, both antegrade and retrograde flow across ileocolonic junction has been observed. Transient retrograde flow can occur across ileocecal valve, but ileum is capable of rapidly clearing any colon reflux. Several studies have shown that ileal propagative waves coordinate with cecal propagating waves. (Reprinted with permission of (13).)

  • FIGURE 3.
    FIGURE 3.

    Delayed small-bowel transit after liquid 111In-DTPA meal (anterior views ). In contrast to Figure 1, small-bowel transit is delayed, with images showing persistent, diffuse activity within multiple proximal loops of small bowel and no arrival of activity in terminal ileum reservoir or ileocolonic junction by 6 h.

  • FIGURE 4.
    FIGURE 4.

    Colon geometric center analysis. Six regions of interest are used to define each segment and formula for calculation.

  • FIGURE 5.
    FIGURE 5.

    Normal and abnormal colon transit patterns. Normal colon transit is reflected by activity predominantly in right colon at 24 h and nearly complete emptying at 72 h. Colon inertia is reflected by failure of activity to progress beyond splenic flexure at 48 and 72 h. Functional rectosigmoid outlet obstruction is reflected by normal progression from right colon to left colon but with retention in rectosigmoid colon at 72 h. Generalized slow colon transit is reflected by diffuse pattern of colon retention at 72 h.

Tables

  • TABLE 1

    Comparison of Adult Dose Estimates for Oral 111In-DTPA vs. 67Ga-Citrate

    Absorbed dose in lower large intestine (mSv)
    RadiopharmaceuticalDose (MBq)Effective dose (mSv)NormalConstipated
    111In-DTPA41.206.411.6
    67Ga-citrate40.746.511.8

    • Modified from (7).

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