Real-time MRI for dynamic assessment of gastroesophageal reflux disease: 
Comparison to pH-metry and impedance.

Seif Amir Hosseini, A.; Uhlig, J.; Streit, U.; Gliem, N.; Wedi, E.; Ellenrieder, V.; Ghadimi, M.; Saheeb, A.; Uecker, M.; Frahm, J.; Lotz, J.; Biggemann, L.

doi:10.1016/j.ejrad.2020.108856

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Real-time MRI for dynamic assessment of gastroesophageal reflux disease: Comparison to pH-metry and impedance.

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Frahm, J.
Research Group of Biomedical NMR, MPI for Biophysical Chemistry, Max Planck Society;

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Citation

Seif Amir Hosseini, A., Uhlig, J., Streit, U., Gliem, N., Wedi, E., Ellenrieder, V., et al. (2020). Real-time MRI for dynamic assessment of gastroesophageal reflux disease: Comparison to pH-metry and impedance. European Journal of Radiology, 125: 108856. doi:10.1016/j.ejrad.2020.108856.

Cite as: https://hdl.handle.net/21.11116/0000-0005-B699-1

Abstract

PURPOSE:

To evaluate the diagnostic potential of real-time MRI for dynamic assessment of gastroesophageal reflux in patients with GERD (gastroesophageal reflux disease)-like symptoms compared to pH-metry and impedance.
METHODS:

Patients who underwent real-time MRI and pH-metry between 2015-2018 were included in this retrospective study. Real-time MRI at 3 T was achieved by undersampled radial FLASH acquisitions with iterative image reconstruction by NLINV. Real-time MRI visualized transit of pineapple juice through the gastroesophageal junction and during Valsalva maneuver. MRI results were compared to 24 h pH-metry to assess acidic reflux (following Lyon Consensus guidelines) and to impedance to assess non-acidic reflux. A standard 2 × 2 table was chosen to calculate diagnostic performance.
RESULTS:

91/93 eligible patients fulfilled inclusion criteria (male n = 49; female n = 42; median age 55 y). All MRI studies were successfully completed without adverse events at a mean examination time of 15 min. On real-time MRI, reflux was evident in 60 patients (66 %). pH-metry revealed reflux in 41 patients (45 %), and impedance in 54 patients (59 %). Compared to pH-metry and impedance, real-time MRI sensitivity was 0.78 (95 % CI: 0.66-0.87), specificity 0.67 (95 % CI: 0.45-0.84) and PPV 0.87 (95 % CI: 0.75-0.94).
CONCLUSION:

Real-time MRI is an imaging method for assessment of gastroesophageal reflux in patients with GERD-like symptoms. Considering its high positive predictive value, real-time MRI can accurately identify patients in which further invasive testing with pH-metry and impedance might be considered.