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Free keywords:
Real-time MRI
Esophagogastric junction
EGJ
High-resolution manometry
HRM
Abstract:
Purpose
To assess the esophagogastric junction (EGJ) on real-time MRI and compare imaging parameters to EGJ morphol-
ogy on high-resolution manometry (HRM).
Methods
A total of 105 of 117 eligible patients who underwent real-time MRI and high-resolution manometry for GERD-
like symptoms between 2015 and 2018 at a single center were retrospectively evaluated (male n = 57; female n = 48; mean
age 52.5 ± 15.4 years). Real-time MRI was performed at a median investigation time of 15 min (1 frame/40 ms). On HRM,
EGJ morphology was assessed according to the Chicago classification of esophageal motility disorders. Real-time MRI was
performed at 3 T using highly undersampled radial fast low-angle shot acquisitions with NLINV image reconstruction. A
10 mL pineapple juice bolus served as oral contrast agent at supine position. Real-time MRI films of the EGJ were acquired
during swallowing events and during Valsalva maneuver. Anatomic and functional MRI parameters were compared to EGJ
morphology on HRM.
Results
On HRM, n = 42 patients presented with EGJ type I (40.0%), n= 33 with EGJ type II (31.4%), and n= 30 with EGJ
type III (28.6%). On real-time MRI, hiatal hernia was more common in patients with EGJ type III (66.7%) than in patients
with EGJ type I (26.2%) and EGJ type II (30.3%; p < 0.001). Sliding hiatal hernia was more frequent in patients with EGJ
type II (33.3%) than in patients with EGJ type III (16.7%) and EGJ type I (7.1%; p = 0.017). The mean esophagus–fundus
angle of patients was 85 ± 31° at rest and increased to 101 ± 36° during Valsalva maneuver.
Conclusion
Real-time MRI is a non-invasive imaging method for assessment of the esophagogastric junction. Real-time
MRI can visualize dynamic changes of the EGJ during swallowing events.
