Lehmann R, Borovicka J, Kunz P, Crelier G, Boesiger P, Fried M, Schwizer W, Spinas G A
Department of Internal Medicine, University and ETH, Zurich, Switzerland.
Diabetes Care. 1996 Oct;19(10):1075-82. doi: 10.2337/diacare.19.10.1075.
Our objective was to validate a new noninvasive magnetic resonance imaging (MRI) technique for diagnosis of delayed gastric emptying by using radio-opaque markers (ROMs) in diabetic patients with and without cardiovascular autonomic (CAN) and peripheral sensomotoric neuropathy (PSN).
Fifteen diabetic outpatients were recruited, eight with CAN and PSN (group A, age 28-61 years, mean diabetes duration 27 years) and seven without CAN (group B, age 28-60 years, mean diabetes duration 16 years). Gastric emptying and motility were assessed with ROMs and MRI in random order. After an overnight fast either a test meal (451 kcal) containing a capsule with 10 ROMs is eaten and a supine plain abdominal X ray is taken after 6 h or 500 ml intralipid 10% (550 kcal) is swallowed for the MRI study, using a 1.5 Tesla Gyroscan ACS II (Philips, Eindohoven, The Netherlands). Computer-assisted segmentation of images was used to measure gastric emptying (T1/2, min) over 125 min, contraction frequency (F, min-1), mean contraction amplitude (CA, % basal), and velocity (V, cm/s). Blood glucose was kept constant at 5.0-8.0 mmol/l.
In group A, 6.1 +/- 1.36 ROMs (mean +/- SE) were retained in the stomach after 6 h and 0 ROM in group B, indicating a significant delay of gastric emptying in patients with CAN. The MRI study revealed a significantly longer gastric emptying (P < 0.005) in group A (T1/2 = 124 +/- 10 min) as compared with group B (T1/2 = 85 +/- 18 min). There was no difference in F, CA, and V between the two groups: F 2.9 +/- 0.07 and 2.7 +/- 0.1 (min-1), CA 26.8 +/- 1.2 and 29.6 +/- 1.6 (% basal), V 0.43 +/- 0.02 and 0.40 +/- 0.02 (cm/s), respectively.
MRI offers the possibility of visualizing and examining exactly the mechanisms responsible for gastric emptying and is characterized by a high specificity but a lower sensitivity as compared with ROMs, which proved to be an ideal screening test for diagnosis of gastroparesis in clinical practice.
我们的目的是通过使用不透X线标志物（ROMs），验证一种用于诊断糖尿病患者胃排空延迟的新型非侵入性磁共振成像（MRI）技术，这些糖尿病患者伴有或不伴有心血管自主神经病变（CAN）和周围感觉运动神经病变（PSN）。
招募了15名糖尿病门诊患者，其中8名伴有CAN和PSN（A组，年龄28 - 61岁，平均糖尿病病程27年），7名不伴有CAN（B组，年龄28 - 60岁，平均糖尿病病程16年）。采用随机顺序，通过ROMs和MRI评估胃排空和胃动力。在禁食过夜后，患者要么进食一顿含有10个ROMs胶囊的试验餐（451千卡），6小时后拍摄仰卧位腹部平片，要么为进行MRI研究吞咽500毫升10%的脂肪乳剂（550千卡），使用1.5特斯拉Gyroscan ACS II（飞利浦，荷兰埃因霍温）。使用计算机辅助图像分割技术测量125分钟内的胃排空（T1/2，分钟）、收缩频率（F，次/分钟）、平均收缩幅度（CA，相对于基础值的百分比）和速度（V，厘米/秒）。血糖保持在5.0 - 8.0毫摩尔/升恒定。
在A组中，6小时后胃内保留6.1±1.36个ROMs（平均值±标准误），而B组为0个，这表明伴有CAN的患者胃排空明显延迟。MRI研究显示，与B组（T1/2 = 85±18分钟）相比，A组（T1/2 = 124±10分钟）的胃排空时间显著延长（P < 0.005）。两组之间的F、CA和V没有差异：F分别为2.9±0.07和2.7±0.1（次/分钟），CA分别为26.8±1.2和29.6±1.6（相对于基础值的百分比），V分别为0.43±0.02和0.40±0.02（厘米/秒）。
MRI能够可视化并精确检查负责胃排空的机制，其特点是特异性高，但与ROMs相比敏感性较低，而ROMs在临床实践中被证明是诊断胃轻瘫的理想筛查试验。
