COMPARISON OF VISUAL AND
SEMIQUANTITATIVE SCINTIGRAPHY FOR GASTROESOPHAGEAL REFLUX
Caglar M, Volkan B, Bozkurt MF
Hacettepe University, Department
of Nuclear Medicine, Ankara, Turkey
Objective: Gastroesophageal reflux
(GER) scintigraphy is a well-established procedure for the detection of GER
in children. This prospective study was undertaken to assess the evaluation
of scintigraphic semiquantitative analysis (SQA) in addition to visual
evaluation to detect GER.
Methods: 99 symptomatic
children; 67 boys, 32 girls (mean age:37.7 months; range:1-144 months) were
evaluated for GER. All children underwent GER scintigraphy with 99mTc
sulfur colloid which was mixed with the patients’ routine milk or formula.
16 seconds sequential images were obtained for 60 minutes. A region of
interest was drawn around the esophagus on the composite images, of which
the time activity curve was generated. 14 patients had extended
intraesophagial pH monitoring (pHM) for 24 hours, in order to study the
correlation between two tests.
Results: 72 children exhibited
GER on scintigraphy both on visual and SQA. Although SQA did not change the
interpretetion, it shortened the diagnosis time by directing the readers’
attention to the reflux episode, especially in the equivocal cases. GER
occured in 67 the patients (92%) during the first 30 minutes. The mean time
of first epizode was 9.2 min. 73 % of the patients with reflux had
radioactivity seen in distal esophagus. 14 of our patients had pHM without
any evidence of reflux.
Conclusions: Our results indicate that scintigraphy
is an effective and reliable test to diagnose GER permits quantitation. 30
and 45 minute imaging, instead of 1 hour can detect 92 % and 97 % of
patients respectively. We conclude that SQA is a diagnostic aid for interpretation.
Extended pHM and scintigraphy may not be used interchangebly since they
measure different pathophysiologic phenomena.