Dynamic MR imaging of the gastroesophageal junction in healthy volunteers during bolus passage

Abstract

Purpose:To evaluate the feasibility of noninvasive dynamic fast magnetic resonance imaging (MRI) during swallowing in healthy volunteers, and to determine esophageal function at the gastroesophageal junction during swallowing. Materials and Methods:A total of 20 healthy volunteers underwent MRI while swallowing in the supine position. Dynamic gradient-echo (GRE) sequences (balanced fast field echo [B-FFE]) were employed in three planes on a 1.5T unit using a phased-array body coil. Buttermilk spiked with gadolinium (Gd) chelate (40:1) for bolus passage was used as an oral contrast agent. We evaluated visualization of esophageal bolus transit, bolus transit time (BTT), peristalsis, identification of the gastroesophageal junction, and reflux during the Valsalva maneuver. Results:The mean visible length of the esophagus was 16.2 Ϯ 5.3 cm in the sagittal view, and 13.8 Ϯ 4.9 cm in the coronal view. In the sagittal view the BTT was defined in 15 of 20 volunteers and was 7.6 Ϯ 1.4 seconds. The BTT in the coronal view was measured in seven of 20 volunteers and was 8 Ϯ 1.3 seconds on average. The axial view yielded higher scores (2.25) than the coronal (1.98) and sagittal (1.78) views for identification of the cardia and during the Valsalva maneuver. Bolus contrast was better displayed in the sagittal (2.2) view than in the coronal (2.08) or axial (1.73) planes. In six volunteers, gastroesophageal abnormalities, such as axial hernia, reflux, and nonperistaltic contractions, were identified. For statistical analysis we used the Friedman test and a one-way analysis of variance (ANOVA). Conclusion:The results indicate that dynamic MR swallowing is a feasible and reproducible technique that warrants further studies in patients.

Is there a role for dynamic swallowing MRI in the assessment of gastroesophageal reflux disease and oesophageal motility disorders?

“…Bolus transit time in seconds (time of swallowing from the pharyngoesophageal sphincter to the gastroesophageal junction) greater than 10 s, and reduced peristalsis or lack of peristalsis as a marker of motility disorders [8,16,17]; 2. Visible gastroesophageal reflux (spontaneous or provoked by a Valsalva maneuver) and an obtuse His angle as a marker of GERD [17].…”

“…The buttermilk-gadolinium mixture (Omniscan 0.5™, GE Healthcare, Oslo, Norway in an-off label use), at a dilution of 40:1 [16], was placed in a cup with a long plastic tube and was placed near the volunteer's head in the MR gantry, so that the other end of the plastic tube could be placed into the volunteer's mouth. To avoid possible complications, such as aspiration, the ability of volunteers to swallow in the supine position was tested outside the magnet before the examination.…”

Effect of complete denture wearing on deglutition time: a cine‐magnetic resonance imaging study

“…It is also possible to evaluate functional findings in the temporomandibular joint (26, 37). Thus, the technique allows for the visualisation of deglutition events (6, 19, 25, 27, 28), transit time (6, 21, 22) and HB and LX motion (21). In the present study, a 1·5‐T superconducting dynamic MRI system with a standard quadrature head coil as a receiver was preferred for the evaluation of deglutition like with the similar researches (6, 19–28).…”

“…Magnetic resonance imaging (MRI) is a novel technique with the highest contrast resolution, and one of the best imaging modality for soft‐tissue imaging and also for tissue characterisation (6). Besides, there are many reports that have referred on the use of kinetic MRI techniques for the evaluation of swallowing in the supine position (6, 19–28).…”

Swallowing MRI for GERD—diagnosis and treatment monitoring

“…At present, MR swallowing has been successfully used in healthy volunteers [8][9][10] and patients with oropharyngeal disorders [11][12][13]. This new method was also reviewed in the assessment of motility disorders [14,15], as well as in the diagnosis of GERD [4,[16][17][18][19].…”