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Esophageal motility: an iconographic essay on dynamic esophageal scintigraphy

Abstracts

This study is an interesting selection of esophageal dynamic images and respective activity/time curves to demonstrate motility ranging from normal to the opposite extreme (advancedstage achalasia). The technique employed was: 4-hour fast, with restriction of smoking, alcohol and caffeine products; anterior 0.5-second imaging during 2 minutes, covering the region from the mouth to the gastric fundus, followed by a planar 20-second image from the same region (normal transit time: < 10 seconds). The collection is based on a twenty-year experience employing a systematization including several parameters, which is able to discriminate patients with normal total esophageal transit time independently of symptoms.

Esophageal scintigraphy; Transit time; Motility; Achalasia; Parameters


Este trabalho é uma seleção interessante de imagens dinâmicas do esôfago e de curvas de atividade/tempo, variando da motilidade normal até o extremo oposto, a acalásia em estado avançado. A técnica é a usual: quatro horas de jejum, com restrição de fumo, álcool e cafeína; incidência anterior; imagens de 0,5 segundo durante dois minutos, região da boca ao fundo gástrico, seguida de imagem plana de 20 segundos da mesma região (tempo de trânsito normal: < 10 segundos). A coletânea é baseada em vinte anos de experiência empregando uma sistematização com vários parâmetros de análise que permite discriminar pacientes com tempo total de trânsito normal.

Cintilografia esofagiana; Tempo de trânsito; Motilidade; Acalásia; Parâmetros


ICONOGRAPHIC ESSAY

Esophageal motility: an iconographic essay on dynamic esophageal scintigraphy* * Study developed in the Department of Radiology – Nuclear Medicine at Faculty of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.

Maria Expósito Penas

PhD, Associate Professor, Department of Radiology – Nuclear Medicine at Faculty of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil

Mailing address Mailing address: Profa. Dra. Maria Expósito Penas Rua Alfredo Corrêa, 150, ap. 204, Ilha do Governador Rio de Janeiro, RJ, Brazil, 21920-225 E-mail: exposito@hucff.ufrj.br

ABSTRACT

This study is an interesting selection of esophageal dynamic images and respective activity/time curves to demonstrate motility ranging from normal to the opposite extreme (advancedstage achalasia). The technique employed was: 4-hour fast, with restriction of smoking, alcohol and caffeine products; anterior 0.5-second imaging during 2 minutes, covering the region from the mouth to the gastric fundus, followed by a planar 20-second image from the same region (normal transit time: < 10 seconds). The collection is based on a twenty-year experience employing a systematization including several parameters, which is able to discriminate patients with normal total esophageal transit time independently of symptoms.

Keywords: Esophageal scintigraphy; Transit time; Motility; Achalasia; Parameters.

INTRODUCTION

The present essay is aimed at showing an interesting selection of images and graphics demonstrating esophageal motility in a spectrum ranging from normal to the opposite extreme that is an advanced-stage achalasia. Besides studies utilizing room-temperature water for radiotracer dilution, further studies (Bernstein tests) were performed with volunteers (with free and informed consent) utilizing mild hydrochloric acid (at 0.1 N and 0.05 N concentration) to reproduce symptoms of gastroesophageal reflux. All of the studies were approached by a standard systematization including the following parameters (for normal values [n]): total esophageal transit time (TETT) (n: < 10.0 s), curve pattern (CP) (n: coordinated), residual activity (RA) (n: < 10%), time for initial entry into stomach (TIES) (n: < 6.0 s), stomach entry form (SEF) (n: abrupt), retrograde movements (RM) (n: absent), curve variation factor (CVF) (n: < 0.1), transit time in the proximal, middle and distal esophageal thirds (PTT, MTT, DTT) (respectively n: < 3.0 s, < 6.0 s and < 10.0 s) and a plain radiographic image of the esophagus (PRI) at the end of the dynamic scintigraphy (n: absent or mild residue)(1–3).

REFERENCES

Received March 8, 2007. Accepted after revision May 8, 2007.

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  • 1. Russell COH, Hill LD, Holmes ER III, Hull DA, Gannon R, Pope CE II. Radionuclide transit: a sensitive screening test for esophageal dysfunction. Gastroenterology 1981;80:887892.
  • 2. Blackwell JN, Hannan WJ, Adam RD, Heading RC. Radionuclide transit studies in the detection of oesophageal dysmotility. Gut 1983;24:421426.
  • 3. Penas ME, Orlando MMC, Koch HA. Dynamic esophageal scintigraphy parameters to analyze in single liquid bolus swallow. Alasbimn J 2006; 8(33).
  • Mailing address:
    Profa. Dra. Maria Expósito Penas
    Rua Alfredo Corrêa, 150, ap. 204, Ilha do Governador
    Rio de Janeiro, RJ, Brazil, 21920-225
    E-mail:
  • *
    Study developed in the Department of Radiology – Nuclear Medicine at Faculty of Medicine, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
  • Publication Dates

    • Publication in this collection
      15 Jan 2008
    • Date of issue
      Dec 2007

    History

    • Accepted
      08 May 2007
    • Received
      08 Mar 2007
    Publicação do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem Av. Paulista, 37 - 7º andar - conjunto 71, 01311-902 - São Paulo - SP, Tel.: +55 11 3372-4541, Fax: 3285-1690, Fax: +55 11 3285-1690 - São Paulo - SP - Brazil
    E-mail: radiologiabrasileira@cbr.org.br