Review ArticleContinuing Education

Gastric Emptying Scintigraphy

Mary Beth Farrell
Journal of Nuclear Medicine Technology June 2019, 47 (2) 111-119; DOI: https://doi.org/10.2967/jnmt.117.227892

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Stomach regions. The proximal fundus functions as a reservoir (accommodation) for food while the distal antrum grinds and mixes food.

  • FIGURE 2.
    FIGURE 2.

    Normal gastric emptying study demonstrating correct regions of interest in both the anterior and posterior projections on initial, 1-hour, 2-hour, and 4-hour images. This image was originally published in JNMT. Vijayakumar V. Assessment of the Practical Role of a Radionuclide Low-Fat-Meal Solid Gastric Emptying Study. J Nucl Med Technol. 2006; 34:82–85. © SNMMI.

  • FIGURE 3.
    FIGURE 3.

    Normal liquid gastric emptying study using 0.5 99mTc-SC added to milk. Anterior and posterior images (right) at 0 and 60 minutes. Half-time emptying curve (left). Images courtesy of Leonie L. Gordon, MD, FACNM Medical University of South Carolina, Charleston, SC.

  • FIGURE 4.
    FIGURE 4.

    Normal solid gastric emptying study. (Top) Anterior and posterior images at 0 and approximately 1, 2 and 4 hours. (Bottom) Region counts from the anterior and posterior images and geometric mean. The percent retention at 4 hours is 8.2%. Images courtesy of Leonie L. Gordon, MD, FACNM Medical University of South Carolina, Charleston, SC.

  • FIGURE 5.
    FIGURE 5.

    Normal gastric emptying curves. For solid meal (red), there is an initial 20-30 m lag period as the antrum reduces meal particle size and mixes with gastric acid. After the lag period, the solid material empties from the stomach in a linear fashion. The liquid meal (purple) immediately begins to leave the stomach and empties in an exponential pattern.

  • FIGURE 6.
    FIGURE 6.

    Abnormal solid gastric emptying study delayed emptying with 20.9% retention at 4 hours. At top, anterior images; at bottom, posterior images. Images courtesy of Jon A. Baldwin, MD, University of Alabama at Birmingham, Birmingham, AL.

  • FIGURE 7.
    FIGURE 7.

    Abnormal gastric emptying study demonstrating delayed emptying and esophageal reflux (arrow). At top: normal intensity display. At bottom: inverted images with increased intensity. Images courtesy of Lorraine M. Fig, MD, FACNM VA Ann Arbor Healthcare System, Ann Arbor, MI.

  • FIGURE 8.
    FIGURE 8.

    Abnormal gastric emptying study demonstrating rapid gastric emptying or dumping syndrome. The percentage retention at 30 minutes, 60 minutes, and 120 minutes was 40%, 5%, and 1%, respectively. Images courtesy of Lorraine M. Fig, MD, FACNM VA Ann Arbor Healthcare System, Ann Arbor, MI.

  • FIGURE 9.
    FIGURE 9.

    Solid gastric emptying study demonstrating the effects of region of interest placement (top). On the immediate image, the region of interest is incorrectly drawn around only the fundus. Residual activity in the esophagus and activity in the antrum is not included. The percent remaining in the stomach at later times is falsely elevated because fewer initial counts (denominator) were used in the calculation. At 4 hours, the percent remaining in the stomach is abnormal at 15.9% (bottom). The region of interest is correctly drawn including the esophagus and antrum. When the counts at 4 hours are divided by this higher total activity, the percentage of meal remaining in the stomach is now normal at 6.4%. Images courtesy of Jon A. Baldwin, MD, University of Alabama at Birmingham, Birmingham, AL.

Tables

  • TABLE 1

    Factors that Affect the Rate of Gastric Emptying

    Factors that Increase the Rate of EmptyingFactors that Decrease the Rate of Emptying
    LiquidsSolids
    Small particle sizeLarge particle size
    Low fiber or low residueHigh fiber
    Proteins and carbohydratesFats
    Low calorieHigh calorie
    Large volumeSmall volume
    AlkalineAcidic
    Hot foodCool food
    Early in the dayLate in the day
    ActivitySedentary
    UprightLying down
    Absence of painPain
    Lying on right sideLying on left side
    MaleFemale
    Prokinetic, erythromycinNarcotics, anticholinergic
    Reserpine, anticholinesterases, guanethidine, cholinergic agents(Atropine), tricyclic antidepressants, phenothiazines
  • TABLE 2

    Standardized Gastric Emptying Meal

    120 g (4 oz.) of liquid egg whites (99% real eggs, cholesterol free, fat-free and low calorie)
    2 slices of white bread
    30 g strawberry jam
    120 ml (4 oz.) water
    18.5–37 MBq (0.5–1.0 mCi) 99mTc-SC
  • TABLE 3

    Normal Solid Gastric Emptying Values

    Imaging TimeLower Normal LimitaUpper Normal Limitb
    0 minutes
    0.5 hours70%
    1 hour30%90%
    2 hours60%
    3 hours30%
    4 hours10%

    • ↵a For the lower normal limit, lower values suggest rapid gastric emptying.

    • ↵b For upper normal limit values, a greater value suggests delayed gastric emptying.

    • Reprinted with permission from Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. J Nucl Med Technol. 2008;36:44–54.

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