Efficacy of oral contrast agents for upper gastrointestinal signal suppression in MRCP: A systematic review of the literature

Abstract

BackgroundOrally administered substances which suppress signals from gastrointestinal fluid can be used to enhance image quality in magnetic resonance cholangiopancreatography (MRCP). In daily practice, the available substances range from commercial products to regular viands such as fruit juices.PurposeTo provide an overview on the significance of and the substances used as gastrointestinal fluid signal suppressors in MRCP.Material and MethodsA systematic review of the existing literature was performed to evaluate the efficacy and efficiency of oral T2-signal suppressors in MRCP.ResultsTwenty-five publications on 16 different oral contrast media were identified. The most commonly used substances were ferumoxsil, ferric ammonium citrate, and pineapple juice. Twenty-three out of 25 publications supported the use of oral signal suppressors in MRCP. Advantages of oral signal suppressors include improved visualization of the pancreatobiliary ductal system, increased help with differential diagnoses, and higher detection rates of relevant diagnoses due to a reduction of overlaying signals.ConclusionThe application of oral substances for gastrointestinal signal suppression in MRCP is recommendable. A variety of substances are used in daily routine with good but varying effectivity and patient tolerance.

Pregnancy and Cancer: the INCIP Project

“…While diffusion-weighted whole-body MRI is a superior alternative to conventional imaging for staging, the diagnostic utility of diffusion-weighted MRI of the breast (without contrast) is still under investigation [15,16]. Also pineapple juice has been introduced as an alternative contrast agent for diffusionweighted whole-body MRI without known negative impact on fetal health [17]. Lactating patients can safely continue breastfeeding after gadolinium-enhanced MRI.…”

Signal suppressions of grape syrup and grape syrup/lemon aqueous solutions in magnetic resonance cholangiopancreatography using heavily T2-weighted pulse sequence

“…Although using thin slices can partially help to solve the problem, due to the duodenum proximity to the pancreatobiliary system, the high signals may be problematic to find pathologies [1]. To overcome this condition, negative contrast agents are orally administered for fasting patients to provide the T2 shortening effect and to suppress the high signals produced by the gastrointestinal tract fluids [3]. An ideal negative oral contrast agent should be nontoxic, easily accepted by the patient, homogeneously distributed through the gastrointestinal tract, not absorbed into the adjacent tissues, inexpensive, and possessing the capability of completely excreted from the gastrointestinal tract [4].…”

“…As commercial chemical products, iron oxide based ferumoxsil [5], oral gadolinum-DTPA [6,7], and ferric ammonium citrate (FerriSeltz) [8] have been used for this purpose. Although ferumoxsil ˗ superparamagnetic iron oxide nanoparticles with siloxane coating ˗ is widely used for MRCP, its metallic taste limits patients' acceptance for ingestion of the required amount of the agent [3]. Natural substances are more easily accepted by patients.…”

“…Various natural substances such as pineapple juice [9], blueberry juice [10], lemon/orange juice [11], date syrup [1], Açai pulp and juice [12,13] black tea [14], and bananas [15] have been investigated for MRCP. The high concentrations of manganese and iron are responsible for the T2 shortening effect of oral negative contrast materials in MRCP [3]. In some cases such as banana, the high percentage of potassium leads to the T2 shortening effect and the subsequent signal suppression [15].…”

“…Of various negative oral contrast agents, ferumoxsil, ferric ammonium citrate, and pineapple juice are among the most commonly used substances for MRCP [3]. However, less palatability of ferumoxsil [19], mild diarrhea with ferric ammonium citrate [8], and lower suppression of fluid signal in the gastrointestinal tract by pineapple juice comparing to ferumoxsil [1] are the problems with these contrast materials for MRCP.…”