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DOI: 10.1055/s-2007-962866
© Georg Thieme Verlag KG Stuttgart · New York
Ultrasound of the Stomach - The EUROSON Lecture 2006
Ultraschall des Magens - Die EUROSON-Vorlesung 2006Publikationsverlauf
received: 15.11.2006
accepted: 5.1.2007
Publikationsdatum:
15. Februar 2007 (online)
Zusammenfassung
Der Magen ist ein faszinierendes Organ. Er vermag sein Volumen erheblich zu vergrößern, um Essen aufzunehmen und nach einer Mahlzeit zu beherbergen, ohne dass diese Erweiterung normalerweise bewusst empfunden wird. Diese Arbeit möchte aufzeigen, wie der transabdominale Ultraschall die strukturellen und funktionellen Abnormitäten des Magens zu offenbaren vermag. Die Magensonografie wurde ursprünglich durchgeführt, um Krankheiten der Magenwand aufzudecken und zu untersuchen. In der Folgezeit wurden verschiedene Methoden entwickelt, um funktionelle Aspekte der Magenpathologie zu untersuchen. Mit Ultraschall kann man Antrumkontraktilität, Magenentleerung, transpylorischen Fluss, Magenform, Verteilung der Mahlzeiten im Mageninneren, Verhalten der Magenmuskulatur sowie das Dehnungsverhalten der Magenwand beurteilen. Für die Untersuchung von Magenkrankheiten kommen auch hochentwickelte Techniken für die 3D-Sonografie und Gewebe-Doppler-Untersuchungen (Strain Rate Imaging) zur Anwendung. Der „Ultrasound-Meal-Accomodation”-Test (U-MAT) kann benutzt werden, um Patienten mit organischer und nicht-organischer Dyspepsie zu charakterisieren. Die Sonografie beinhaltet noch ein großes Potenzial als klinische Methode, und vielleicht erhalten unsere Patienten eines Tages Diagnose und Therapie in der gleichen Sitzung.
Abstract
The stomach is a fascinating organ. It has the capacity to expand its volume substantially to receive and accommodate food after a meal, normally without any conscious notice of the expansion. The aim of this paper is to show how transabdominal ultrasonography can disclose the structural and functional abnormalities of the stomach. Ultrasound of the stomach was initially performed to detect and investigate organic diseases of the gastric wall. Subsequently, different methods were developed to study functional aspects of gastric pathology. Ultrasound can be used to evaluate antral contractility, gastric emptying, transpyloric flow, gastric configuration, intragastric distribution of meals, gastric accommodation and strain measurement of the gastric wall. Advanced methods for 3D ultrasound imaging and tissue Doppler (Strain Rate Imaging) have also been developed to study diseases of the stomach.The Ultrasound Meal Accommodation Test (U-MAT) can be applied to characterise patients with organic and non-organic dyspepsia. Ultrasonography still has a great potential as a clinical method, and some day our patients may receive both diagnosis and treatment in the same session.
Key words
abdomen - stomach - 3-D ultrasound - ultrasound 2D - ultrasound-Doppler
References
- 1 Galen n nn. Opera Omnia. Leipzig; 1822: 275-281
- 2 Cannon W B, Lieb C W. The receptive relaxation of the stomach. Am J Physiol. 1911; 29 267-273
- 3 Grey E G. Observations on the postural activity of the stomach. Am J Physiol. 1918; 45 272-285
- 4 Azpiroz F, Malagelada J R. Physiological variations in canine gastric tone measured by an electronic barostat. Am J Physiol. 1985; 248 G229-G237
- 5 Jahnberg T. Gastric adaptive relaxation. Effects of vagal activation and vagotomy. An experimental study in dogs and in man. Department of Surgery, Sahlgren’s Hospital, Gøteborg, Department of Physiology, University of Gøteborg 1977
- 6 Desai K M, Sessa W C, Vane J R. Involvement of nitric oxide in the reflex relaxation of the stomach to accommodate food or fluid. Nature. 1991; 351 477-479
- 7 Walls W J. The evaluation of malignant gastric neoplasms by ultrasonic B-scanning. Radiology. 1976; 118 159-163
- 8 Rapaccini G L, Aliotta A, Pompili M. et al . Gastric wall thickness in normal and neoplastic subjects: a prospective study performed by abdominal ultrasound. Gastrointest Radiol. 1988; 13 197-199
- 9 Mascatello V J, Carrera G F, Telle R L. et al . The ultrasonic demonstration of gastric lesions. JCU J Clin Ultrasound. 1977; 5 383-387
- 10 Lutz H T, Petzoldt R. Ultrasonic patterns of space occupying lesions of the stomach and the intestine. Ultrasound Med Biol. 1976; 2 129-132
- 11 Tomooka Y, Onitsuka H, Goya T. et al . Ultrasonography of benign gastric ulcers. Characteristic features and sequential follow-ups. J Ultrasound Med. 1989; 8 513-517
- 12 Joharjy I A, Mustafa M A, Zaidi A J. Fluid-aided sonography of the stomach and duodenum in the diagnosis of peptic ulcer disease in adult patients. J Ultrasound Med. 1990; 9 77-84
- 13 Lutz H, Bauer U, Stolte M. Ultrasound diagnosis of the stomach wall - experimental studies. Ultraschall in Med. 1986; 7 255-258
- 14 Meiser G, Meissner K. Sonographic diagnosis of complicated peptic ulcer. Ultraschall in Med. 1986; 7 268-274
- 15 Deeg K H, Zeilinger G, Bowing B. et al . Sonographic diagnosis of hypertrophic pyloric stenosis in childhood. Ultraschall in Med. 1985; 6 320-324
- 16 Warren P S, Garrett W J, Kossoff G. The liquid-filled stomach - an ultrasonic window to the upper abdomen. J Clin Ultrasound. 1978; 6 315-320
- 17 Worlicek H. Sonographic diagnosis of the fluid-filled stomach. Ultraschall in Med. 1986; 7 259-263
- 18 Weighall S L, Wolfman N T, Watson N. The fluid-filled stomach: a new sonic window. J Clin Ultrasound. 1979; 7 353-356
- 19 Bateman D N, Leeman S, Metreweli C. et al . A non-invasive technique for gastric motility measurement. Br J Radiol. 1977; 50 526-527
- 20 Holt S, McDicken W N, Anderson T. et al . Dynamic imaging of the stomach by real-time ultrasound - a method for the study of gastric motility. Gut. 1980; 21 597-601
- 21 Hausken T, Berstad A. Wide gastric antrum in patients with non-ulcer dyspepsia. Effect of cisapride. Scand J Gastroenterol. 1992; 27 427-432
- 22 Hausken T, Odegaard S, Berstad A. Antroduodenal motility studied by real-time ultrasonography. Effect of enprostil. Gastroenterology. 1991; 100 59-63
- 23 Ahluwalia N K, Thompson D G, Mamtora H. et al . Evaluation of human postprandial antral motor function using ultrasound. Am J Physiol. 1994; 266 G517-G522
- 24 Wedmann B, Adamek R J, Wegener M. Ultrasound detection of gastric antrum motility - evaluating a simple semiquantitative method. Ultraschall in Med. 1995; 16 124-126
- 25 Hveem K, Sun W M, Hebbard G. et al . Insights into stomach mechanics from concurrent gastric ultrasound and manometry. Gastroenterology. 1995; 107 1236
- 26 Hveem K, Svebak S, Hausken T. et al . Effect of mental stress and cisapride on autonomic nerve functions in functional dyspepsia. Scand J Gastroenterol. 1998; 33 123-127
- 27 Bateman D N, Whittingham T A. Measurement of gastric emptying by real-time ultrasound. Gut. 1982; 23 524-527
- 28 Bolondi L, Bortolotti M, Santi V. et al . Measurement of gastric emptying time by real-time ultrasonography. Gastroenterology. 1985; 89 752-759
- 29 Holt S, Cervantes J, Wilkinson A A. et al . Measurement of gastric emptying rate in humans by real-time ultrasound. Gastroenterology. 1986; 90 918-923
- 30 Duan L P, Zheng Z T, Li Y N. A study of gastric emptying in non-ulcer dyspepsia using a new ultrasonographic method. Scand J Gastroenterol. 1993; 28 355-360
- 31 Ricci R, Bontempo I, Corazziari E. et al . Real time ultrasonography of the gastric antrum. Gut. 1993; 34 173-176
- 32 Desaga J F, Hixt U. Sonographic determination of gastric emptying. Ultraschall in Med. 1987; 8 138-141
- 33 Gerards C, Tromm A, May B. Optimizing antrum planimetry for ultrasound determination of gastric emptying using emptying function reference lines. Ultraschall in Med. 1998; 19 83-86
- 34 Marzio L, Giacobbe A, Conoscitore P. et al . Evaluation of the use of ultrasonography in the study of liquid gastric emptying. Am J Gastroenterol. 1989; 84 496-500
- 35 Tympner F, Feldmeier J, Rosch W. Study of the correlation of sonographic and scintigraphic results in measuring stomach emptying. Ultraschall in Med. 1986; 7 264-267
- 36 Odegaard S, Gilja O H, Gregersen H. Basic and New Aspects of Gastrointestinal Ultrasonography. Advanced Series in Biomechanics. Book Singapore; World Scientific 2005: 1-502
- 37 King P M, Adam R D, Pryde A. et al . Relationships of human antroduodenal motility and transpyloric fluid movement: non-invasive observations with real-time ultrasound. Gut. 1984; 25 1384-1391
- 38 Hausken T, Odegaard S, Matre K. et al . Antroduodenal motility and movements of luminal contents studied by duplex sonography. Gastroenterology. 1992; 102 1583-1590
- 39 Hausken T, Gilja O H, Undeland K A. et al . Timing of postprandial dyspeptic symptoms and transpyloric passage of gastric contents. Scand J Gastroenterol. 1998; 33 822-827
- 40 Hausken T, Gilja O H, Odegaard S. et al . Flow across the human pylorus soon after ingestion of food, studied with duplex sonography. Effect of glyceryl trinitrate. Scand J Gastroenterol. 1998; 33 484-490
- 41 Uematsu M, Nakatani S, Yamagishi M. et al . Usefulness of myocardial velocity gradient derived from two-dimensional tissue Doppler imaging as an indicator of regional myocardial contraction independent of translational motion assessed in atrial septal defect. Am J Cardiol. 1997; 79 237-241
- 42 Grubb N R, Fleming A, Sutherland G R. et al . Skeletal muscle contraction in healthy volunteers: assessment with Doppler tissue imaging. Radiology. 1995; 194 837-842
- 43 Gregersen H, Barlow J, Thompson D. Development of a computer-controlled tensiometer for real-time measurements of tension in tubular organs. Neurogastroenterol Motil. 1999; 11 109-118
- 44 Matre K, Stokke E M, Martens D. et al . In vitro volume estimation of kidneys using three-dimensional ultrasonography and a position sensor. Eur J Ultrasound. 1999; 10 65-73
- 45 Ahmed A B, Gilja O H, Gregersen H. et al . In vitro strain measurement in the porcine antrum using ultrasound doppler strain rate imaging. Ultrasound Med Biol. 2006; 32 513-522
- 46 Gilja O H, Heimdal A, Hausken T. et al . Strain during gastric contractions can be measured using Doppler Ultrasonography. Ultrasound Med Biol. 2002; 28 1457-1465
- 47 Heimdal A, Gilja O H. Strain Rate Imaging - A new tool for studying th GI tract. Odegaard S, Gilja OH, Gregersen H Basic and new aspects of gastrointestinal ultrasonography Singapore; World Scientific 2005: 243-263
- 48 Gilja O H, Hausken T, Odegaard S. et al . Monitoring postprandial size of the proximal stomach by ultrasonography. J Ultrasound Med. 1995; 14 81-89
- 49 Gilja O H, Hausken T, Wilhelmsen I. et al . Impaired accommodation of proximal stomach to a meal in functional dyspepsia. Dig Dis Sci. 1996; 41 689-696
- 50 Gilja O H, Hausken T, Bang C J. et al . Effect of glyceryl trinitrate on gastric accommodation and symptoms in functional dyspepsia. Dig Dis Sci. 1997; 42 2124-2131
- 51 Undeland K A, Hausken T, Gilja O H. et al . Gastric meal accommodation studied by ultrasound in diabetes. Relation to vagal tone. Scand J Gastroenterol. 1998; 33 236-241
- 52 Tefera S, Gilja O H, Hatlebakk J G. et al . Gastric accommodation studied by ultrasonography in patients with reflux esophagitis. Dig Dis Sci. 2001; 46 618-625
- 53 Izbeki F, Kiss I, Wittmann T. et al . Impaired accommodation of proximal stomach in patients with alcoholic liver cirrhosis. Scand J Gastroenterol. 2002; 37 1403-1410
- 54 Olafsdottir E, Gilja O H, Aslaksen A. et al . Impaired accommodation of the proximal stomach in children with recurrent abdominal pain. J Pediatr Gastroenterol Nutr. 2000; 30 157-163
- 55 Vingerhagen S, Hausken T, Gilja O H. et al . Influence of a 5HT1 receptor agonist on gastric accommodation and initial transpyloric flow in healthy subjects. Neurogastroenterol Motil. 2000; 12 95-101
- 56 Mundt M W, Hausken T, Samsom M. Effect of intragastric barostat bag on proximal and distal gastric accommodation in response to liquid meal. Am J Physiol Gastrointest Liver Physiol. 2002; 283 G681-G686
- 57 Gilja O H, Thune N, Matre K. et al . In vitro evaluation of three-dimensional ultrasonography in volume estimation of abdominal organs. Ultrasound Med Biol. 1994; 20 157-165
- 58 Thune N, Hausken T, Gilja O H. et al . A practical method for estimating enclosed volumes using 3D ultrasound. Eur J Ultrasound. 1996; 3 83-92
- 59 Gilja O H, Smievoll A I, Thune N. et al . In vivo comparison of 3D ultrasonography and magnetic resonance imaging in volume estimation of human kidneys. Ultrasound Med Biol. 1995; 21 25-32
- 60 Hokland J, Hausken T. An interactive volume rendering method applied to ultrasonography of abdominal structures. IEEE Ultrason Symp Proc. 1994; 3 1567-1571
- 61 Hausken T, Thune N, Matre K. et al . Volume estimation of the gastric antrum and the gallbladder in patients with non-ulcer dyspepsia and erosive prepyloric changes, using three-dimensional ultrasonography. Neurogastroenterol Mot. 1994; 6 263-270
- 62 Gilja O H, Hausken T, Odegaard S. et al . Three-dimensional ultrasonography of the gastric antrum in patients with functional dyspepsia. Scand J Gastroenterol. 1996; 31 847-855
- 63 Berstad A, Hausken T, Gilja O H. et al . Volume measurement of gastric antrum by 3-D ultrasonography and flow measurements through the pylorus by duplex technique. Dig Dis Sci. 1994; 39 97-100
- 64 Detmer P R, Bashein G, Hodges T C. et al . 3D ultrasonic image feature localization based on magnetic scanhead tracking: In vitro calibration and validation. Ultrasound Med Biol. 1994; 20 923-936
- 65 Hodges T C, Detmer P R, Burns D H. et al . Ultrasonic three-dimensional reconstruction: In vitro and in vivo volume and area measurement. Ultrasound Med Biol. 1994; 20 719-729
- 66 Gilja O H, Detmer P R, Jong J M. et al . Intragastric distribution and gastric emptying assessed by 3D-ultrasonography. Gastroenterology. 1997; 113 38-49
- 67 Tefera S, Gilja O H, Olavsdottir E. et al . Intragastric maldistribution of a liquid meal in patients with reflux oesophagitis assessed by three dimensional ultrasonography. Gut. 2002; 50 153-158
- 68 Tack J, Piessevaux H, Coulie B. et al . Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology. 1998; 115 1346-1352
- 69 Ahluwalia N K, Thompson D G, Barlow J. et al . Relaxation responses of the human proximal stomach to distension during fasting and after food. Am J Physiol. 1994; 267 G166-G172
- 70 Berstad A, Hausken T, Gilja O H. et al . Gastric accommodation in functional dyspepsia. Scand J Gastroenterol. 1997; 32 193-197
- 71 Hjelland I E, Ofstad A P, Narvestad J K. et al . Drink tests in functional dyspepsia: which drink is best?. Scand J Gastroenterol. 2004; 39 933-937
- 72 Liao D, Gregersen H, Hausken T. et al . Analysis of surface geometry of the human stomach using real-time 3-D ultrasonography in vivo. Neurogastroenterol Motil. 2004; 16 315-324
- 73 Hausken T, Li X -N, Goldman B. et al . Quantification of gastric emptying and duodenogastric reflux stroke volumes using three-dimensional guided digital color Doppler Imaging. Eur J Ultrasound. 2001; in press
- 74 Riccabona M, Nelson T R, Pretorius D H. et al . Distance and volume measurement using three-dimensional ultrasonography. J Ultrasound Med. 1995; 14 881-886
- 75 Sapin P M, Schroeder K D, Smith M D. et al . Three-dimensional echocardiographic measurement of left ventricular volume in vitro: comparison with two-dimensional echocardiography and cineventriculography. J Am Coll Cardiol. 1993; 22 1530-1537
- 76 Kyei Mensah A, Zaidi J, Pittrof R. et al . Transvaginal three-dimensional ultrasound: accuracy of follicular volume measurements. Fertil Steril. 1996; 65 371-376
- 77 Stein W W, Brettel H F, Garten T. Stomach volume determination using the ultrasonic B picture method. Munch Med Wochenschr. 1972; 114 1871-1873
- 78 Whittingham T A, Bateman D N. Measurement of stomach volume by real-time ultrasound. Ultrasound Med Biol. 1983; Suppl 2 459-463
- 79 Gregersen H, Gilja O H, Hausken T. et al . Mechanical properties in the human gastric antrum using B-mode ultrasonography and antral distension. Am J Physiol Gastrointest Liver Physiol. 2002; 283 G368-G375
Prof. Odd Helge Gilja
National Centre for Ultrasound in Gastroenterology, Dep. Of Medicine
Haukeland University Hospital
5021 Bergen
Telefon: ++47/55/97 50 00
Fax: ++47/55/97 29 50
eMail: odd.gilja@uib.no