ESOPHAGEAL SCINTIGRAPHY OF SYSTEMIC-SCLEROSIS

Esophageal involvement is common in systemic sclerosis, and esophageal scintigraphy can be used to detect and follow esophageal dysfunction. This study assesses the value of visual and quantitative analysis of esophageal scintigraphy performed as a multiple swallow test in normal s and patients with systemic sclerosis. Methods: Forty patients with s ystemic sclerosis and 40 sex- and age-matched healthy subjects (contro ls) were studied. A multiple swallow technique was used and both quant itative and qualitative analyses were performed. Visual analysis of co ndensed images was performed independently by two physicians. Each swa llow was assigned a score on a scale from 1 to 4. In the quantitative analysis, time-activity curves based on the mean condensed images were used to calculate the following 3 parameters: residual activity 12 or 25 sec after the beginning of the swallow, measured with or without b aseline correction, respectively, and time from onset of swallow to 50 % of peak activity. Results: Both visual and quantitative analysis sho wed a highly significant (p < 0.001) difference between the patient gr oup and the control group. Visual analysis was best reflected by the r esidual activity 25 sec after the beginning of the swallow without cor rection for background. Receiver operating characteristic curves were used to study the ability to separate the two groups using visual or q uantitative analysis. A high rate of positive tests in the patient gro up was achieved only at the cost of a relatively high rate of positive tests in the control group. Conclusion: Our results indicate high var iability in esophageal motility in controls. This variability impairs the possibilities of developing a screening test to identify asymptoma tic patients early in the disease course.