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

Abstract

• Swallowing MRI can assess anatomy and function of the gastroesophageal-junction • Swallowing MRI can help identifying reflux and motility disorders • Definition of the size of hiatal hernias is possible in all three planes in MR. • Short duration of swallowing MRI enables its application in routine clinical practice.

Swallowing MRI for GERD—diagnosis and treatment monitoring

“…With these planes, reflux events can be studied quite well (Fig. 2), and the literature reports a good correlation between 83 and 91% with the DeMeester score in pHmetric studies [16,18]. Other parameters, such as diaphragm-to-sphincter distance, sphincter length, as well as sphincter-transit-time, showed significant differences between healthy volunteers and symptomatic patients [18].…”

“…Dynamic swallowing MRI has become a valuable tool in the assessment of morphological and functional imaging of the esophagus [4,16,18] in patients with typical GERD symptoms. Magnetic resonance swallowing is a noninvasive procedure without ionizing radiation and without the administration of intravenous contrast medium, and thus it could also be used for pediatric or pregnant patients.…”

“…Compared with a barium swallow, MR swallowing offers the possibility of multiplanar imaging in any desired plane, and thus the course of the esophagus and the gastroesophageal junction can be adjusted very precisely. The best coverage of the esophagus, which is the main challenge of this examination technique, can be reached with a combination of doubleoblique sagittal and coronal views ( [16]; Fig. 1).…”

“…The detection and measurements of a hiatal hernia illustrates one of the main strengths of swallowing MRI. Exact measurements of the size of a hiatal hernia are possible in any desired plane [16]. The size of an axial hernia shows a strong correlation with the grade of the reflux [7].…”

“…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]. Since 2014, it has been used to monitor treatment after antireflux surgery [20][21][22].…”