Assessment of fundal accommodation in solid meal gastric emptying scintigraphy: a retrospective analysis

Aim To investigate the feasibility of both quantitative and qualitative assessment of fundal accommodation during solid meal gastric emptying (SGE) scintigraphy. Methods SGE scintigraphy studies of 72 patients were retrospectively evaluated. Regions of interest (ROIs) were generated on the stomach at different times (0, 30 min, 1, 2, 3, and 4 h), and the corresponding retention percentages were calculated. Counts as geometric means from anterior and posterior ROIs over proximal stomach half and whole stomach at zero-time were used to calculate gastric fundal accommodation ratio (FAR). The radioactivity at the fundus was visually assessed at zero-time image to generate a four-point fundal accommodation visual score (1 = abnormal, 2 = probably abnormal, 3 = probably normal, and 4 = normal). Results Fifty patients had normal SGE, and 22 had delayed SGE. The mean FAR was 0.753 ± 0.151. The fundal accommodation visual score and the FAR were significantly moderately correlated ( ρ = 0.455, P < 0.0001). Receiver operating characteristic curve analysis revealed a FAR cut-off value of 0.669 distinguishing normal from abnormal FAR (area under the curve = 0.873; P < 0.001) with 70% sensitivity and 92.3% specificity. A comparison of the fundal accommodation visual score and FAR revealed highly significant agreement ( P < 0.0001). Conclusion A fundal radioactivity to total stomach ratio of 0.669 at zero-time image was an appropriate threshold for detecting abnormal fundal accommodation. Given the high correlation between visual scoring and quantitative ratios, visual assessment may be regarded as a quick and dependable way to evaluate fundal accommodation.