Ali Seif Amir Hosseini1, Johannes Uhlig2, Ulrike Streit2, Nina Gliem3, Edris Wedi3, Volker Ellenrieder3, Michael Ghadimi4, Saheeb Ahmed2, Martin Uecker5, Jens Frahm6, Joachim Lotz5, Lorenz Biggemann2. 1. Department of Diagnostic and Interventional Radiology, University Medical Center, Göttingen, 37075, Germany. Electronic address: ali.seif@med.uni-goettingen.de. 2. Department of Diagnostic and Interventional Radiology, University Medical Center, Göttingen, 37075, Germany. 3. Department of Gastroenterology and Gastrointestinal Oncology, University Medical Center, Göttingen, Germany. 4. Department of General, Visceral, and Paediatric Surgery, University Medical Center, Göttingen, Germany. 5. Department of Diagnostic and Interventional Radiology, University Medical Center, Göttingen, 37075, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Göttingen, Germany. 6. Biomedical NMR, Max-Planck-Institute for Biophysical Chemistry, Göttingen, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site, Göttingen, Germany.
Abstract
PURPOSE: To evaluate the diagnostic potential of real-time MRI for dynamic assessment of gastroesophageal reflux in patients with GERD (gastroesophageal reflux disease)-like symptoms compared to pH-metry and impedance. METHODS: Patients who underwent real-time MRI and pH-metry between 2015-2018 were included in this retrospective study. Real-time MRI at 3 T was achieved by undersampled radial FLASH acquisitions with iterative image reconstruction by NLINV. Real-time MRI visualized transit of pineapple juice through the gastroesophageal junction and during Valsalva maneuver. MRI results were compared to 24 h pH-metry to assess acidic reflux (following Lyon Consensus guidelines) and to impedance to assess non-acidic reflux. A standard 2 × 2 table was chosen to calculate diagnostic performance. RESULTS: 91/93 eligible patients fulfilled inclusion criteria (male n = 49; female n = 42; median age 55 y). All MRI studies were successfully completed without adverse events at a mean examination time of 15 min. On real-time MRI, reflux was evident in 60 patients (66 %). pH-metry revealed reflux in 41 patients (45 %), and impedance in 54 patients (59 %). Compared to pH-metry and impedance, real-time MRI sensitivity was 0.78 (95 % CI: 0.66-0.87), specificity 0.67 (95 % CI: 0.45-0.84) and PPV 0.87 (95 % CI: 0.75-0.94). CONCLUSION: Real-time MRI is an imaging method for assessment of gastroesophageal reflux in patients with GERD-like symptoms. Considering its high positive predictive value, real-time MRI can accurately identify patients in which further invasive testing with pH-metry and impedance might be considered.
PURPOSE: To evaluate the diagnostic potential of real-time MRI for dynamic assessment of gastroesophageal reflux in patients with GERD (gastroesophageal reflux disease)-like symptoms compared to pH-metry and impedance. METHODS:Patients who underwent real-time MRI and pH-metry between 2015-2018 were included in this retrospective study. Real-time MRI at 3 T was achieved by undersampled radial FLASH acquisitions with iterative image reconstruction by NLINV. Real-time MRI visualized transit of pineapple juice through the gastroesophageal junction and during Valsalva maneuver. MRI results were compared to 24 h pH-metry to assess acidic reflux (following Lyon Consensus guidelines) and to impedance to assess non-acidic reflux. A standard 2 × 2 table was chosen to calculate diagnostic performance. RESULTS: 91/93 eligible patients fulfilled inclusion criteria (male n = 49; female n = 42; median age 55 y). All MRI studies were successfully completed without adverse events at a mean examination time of 15 min. On real-time MRI, reflux was evident in 60 patients (66 %). pH-metry revealed reflux in 41 patients (45 %), and impedance in 54 patients (59 %). Compared to pH-metry and impedance, real-time MRI sensitivity was 0.78 (95 % CI: 0.66-0.87), specificity 0.67 (95 % CI: 0.45-0.84) and PPV 0.87 (95 % CI: 0.75-0.94). CONCLUSION: Real-time MRI is an imaging method for assessment of gastroesophageal reflux in patients with GERD-like symptoms. Considering its high positive predictive value, real-time MRI can accurately identify patients in which further invasive testing with pH-metry and impedance might be considered.
Authors: Erin J Song; Rena Yadlapati; Joan W Chen; Alice Parish; Matthew J Whitson; Karthik Ravi; Amit Patel; Dustin A Carlson; Abraham Khan; Donna Niedzwiecki; David A Leiman Journal: Dis Esophagus Date: 2022-05-10 Impact factor: 2.822