Assessment of esophagogastric junction morphology by dynamic real-time MRI: 
comparison of imaging features to high-resolution manometry

Biggemann, L.; Uhlig, J.; Gliem, N.; Al-Bourini, O.; Wedi, E.; Ellenrieder, V.; Ghadimi, M.; Uecker, M.; Frahm, J.; Lotz, J.; Hosseini, A. S. A.; Streit, U.

doi:101007/s11604-021-01210-9

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Assessment of esophagogastric junction morphology by dynamic real-time MRI: comparison of imaging features to high-resolution manometry

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

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Zitation

Biggemann, L., Uhlig, J., Gliem, N., Al-Bourini, O., Wedi, E., Ellenrieder, V., et al. (2022). Assessment of esophagogastric junction morphology by dynamic real-time MRI: comparison of imaging features to high-resolution manometry. Japanese Journal of Radiology, 40, 376-384. doi:101007/s11604-021-01210-9.

Zitierlink: https://hdl.handle.net/21.11116/0000-000A-79E5-C

Zusammenfassung

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.