Concentrated pineapple juice for visualisation of the oesophagus during magnetic resonance angiography before atrial fibrillation radiofrequency catheter ablation

Abstract

The purpose of this study was to compare in vitro pineapple juice and a solution of concentrated pineapple juice with a paramagnetic contrast agent in order to determine the feasibility of using the solution of concentrated pineapple juice in vivo for oesophagus visualisation at magnetic resonance angiography (MRA) before the radiofrequency catheter ablation procedure for atrial fibrillation. The pineapple juice was concentrated by a microwave heating evaporation process performed in a domestic microwave oven. Five grams of modified potato starch for every 40 mL of concentrated pineapple juice were added to the concentrated pineapple juice in order to thicken the solution. The solution resulted visually and quantitatively as hyperintense as the contrast agent in vitro (ratio = 1.02). in vivo, no technical difficulties were encountered during the MRA acquisition and a complete enhanced oesophagus was obtained in 37/38 patients (97.4%). The volumetric analysis and the three-dimensional reconstruction were feasible; the quality was rated as diagnostic in every patient. The intensified oesophagus was successfully merged into the electro-anatomical maps in all the patients. In summary, we demonstrated that this technique allows a feasible and safe oesophagus visualisation during MRA.

Origin of the MRI Contrast in Natural and Hydrogel Formulation of Pineapple Juice

“…Pineapple juice has been shown effective as an oral contrast agent in magnetic resonance images, and, more recently, concentrated juices added with hydrogels [ 15 ] have been proposed to further enhance the contrast. However, so far, no detailed studies were performed on natural juices or on their derivatives to characterize the relaxation properties in detail.…”

The Role of Magnetic Resonance Imaging in the Management of Esophageal Cancer

“…Assessment of distant metastases in EC is currently done with CT and 18 F-FDG-PET/CT. As previously mentioned, a 2004 meta-analysis evaluating the performance of 18 F-FDG-PET/CT for the diagnosis of distant metastases found a pooled sensitivity and specificity of 67% (95% CI: 58-76) and 97% (95% CI: 90-100), respectively [26]. In the 2008 meta-analysis by Van Vliet at al., sensitivities and specificities for the diagnosis of distant metastases were 71% (95% CI: 62-79) and 93% (95% CI: 89-97) for 18 F-FDG-PET/CT, 52% (95% CI: 33-71) and 91% (95% CI: 86-96) for CT [46].…”

“…CT can be reliable when it comes to determining resectability by excluding high T-stages tumors [24,25]. 18 Ffluorodeoxyglucose ( 18 F-FDG) PET/CT has a limited role for T-staging due to its low spatial resolution and is mainly useful for the diagnosis of distant metastases [24,26]. Although the local and regional staging accuracy of EUS is greater than those of CT and PET [27], EUS is invasive and operator dependent, and sometimes limited by tumor stenosis [28].…”

“…In 2009, a study on 24 consecutive patients with EC showed that whole body DWI with background body signal suppression did not result in major diagnostic improvements for N-staging [58]. Recent evidence from a 2020 study on 76 patients suggested otherwise, with DWI showing higher sensitivity than 18 F-FDG-PET/CT for the diagnosis of metastatic lymph node in ESCC [59]. In 35 patients with EC, ECG-triggered 1.5 T MRI with turbo spin-echo (TSE) and fast short tau inversion recovery (STIR) fat suppression yielded 81% sensitivity and 98% specificity for the diagnosis of lymph node involvement [60].…”

Contribution of magnetic resonance imaging to the management of esophageal diseases: A systematic review

“…A recent study reported the use of concentrated pineapple juice mixed with potatoe starch an as intraluminal agent for MRI examination of the esophagus. This mixture allowed a feasible and safe esophageal visualisation, with a patient acceptability and an image quality similar to paramagnetic contrast agents (24).…”