Image processing in esophageal scintigraphy: topography of transit times

In the investigation of esophageal transport, the knowledge provided by scintigraphy is mostly based upon the extraction as well as representation of the information obtained. Recently, new tools have been developed for use in computer-based image processing which have made visualization and quantitation of esophageal bolus transport possible through depiction of the 'topography of transit times'. Data extracted from the images obtained in multiple swallowing studies from a single healthy volunteer as well as in patients suffering from gastroesophageal reflux disease (GERD) and from Barrett's esophagus are compressed, filtered and depicted in quantifiable concise plots or multidimensional images. Profile plots demonstrated a considerable increase in local transit times along the esophagus superimposed, however, by a distinctive pattern of local delays. Above the level of the lower esophageal sphincter (LES), the bolus accumulates in a functional ampulla. Subprocesses of bolus transit through the LES, disclosed by spatiotemporal enhancement, allow for the differentiation between mass transit of the bolus and closure of the LES which was considerably retarded in the case of the patient with Barrett's esophagus. The image-processing tools developed for topographic visualization of transit times for esophageal bolus transport have greatly improved the extraction and quantifiable depiction of information obtained by scintigraphy. This can be used for definition of pathognomonic indices.