Gastroenterology Division, Yokohama City University School of Medicine, Yokohama, Japan.
Am J Gastroenterol. 2013 Jul;108(7):1130-9. doi: 10.1038/ajg.2013.57. Epub 2013 Mar 19.
Chronic intestinal pseudo-obstruction (CIPO) is a rare, serious motility disorder, with life-threatening complications over time. However, lack of an established, non-invasive diagnostic method has caused delays in the diagnosis of this intractable disease. Cine-magnetic resonance imaging (MRI) is an emerging technique, with a potential to evaluate the motility of the entire bowel. We compared small bowel motility in healthy volunteers, patients with irritable bowel syndrome (IBS), and those with CIPO, using cine-MRI, and evaluated the usefulness of cine-MRI as a novel diagnostic method for CIPO.
Twelve healthy volunteers, IBS patients, and CIPO patients prospectively underwent cine-MRI at 1.5 T. Luminal diameter, contraction ratio, and contraction cycle were measured and compared between the groups.
Cine-MRI provided sufficient dynamic images to assess the motility of the entire small bowel. Luminal diameter (mean±s.d.) in CIPO patients was significantly higher than that in healthy volunteers and IBS patients (43.4±14.1, 11.1±1.5, and 10.9±1.9 mm, respectively), and contraction ratio was significantly lower in CIPO patients than that in healthy volunteers and IBS patients (17.1±11.0%, 73.0±9.3%, and 74.6±9.4%, respectively). No significant differences were observed in the contraction cycle.
This study is the first to assess the clinical utility of cine-MRI in CIPO patients. Cine-MRI clearly detected contractility impairments in CIPO patients. Cine-MRI is noninvasive, radiation-free, and can directly evaluate the entire small bowel peristalsis, and can detect the affected loops at a glance; therefore, it might be extremely useful for the diagnosis and follow-up of CIPO patients in clinical practice.
慢性肠道假性梗阻（CIPO）是一种罕见且严重的运动障碍，随着时间的推移会出现危及生命的并发症。然而，由于缺乏既定的非侵入性诊断方法，导致这种难治性疾病的诊断出现延误。电影磁共振成像（cine-MRI）是一种新兴技术，具有评估整个肠道运动的潜力。我们使用 cine-MRI 比较了健康志愿者、肠易激综合征（IBS）患者和 CIPO 患者的小肠运动，并评估了 cine-MRI 作为 CIPO 新型诊断方法的有用性。
12 名健康志愿者、IBS 患者和 CIPO 患者前瞻性地在 1.5T 磁共振上进行 cine-MRI。测量并比较各组的管腔直径、收缩比和收缩周期。
cine-MRI 提供了足够的动态图像来评估整个小肠的运动。CIPO 患者的管腔直径（平均值±标准差）明显高于健康志愿者和 IBS 患者（分别为 43.4±14.1、11.1±1.5 和 10.9±1.9mm），收缩比明显低于健康志愿者和 IBS 患者（分别为 17.1±11.0%、73.0±9.3%和 74.6±9.4%）。收缩周期无显著差异。
本研究首次评估了 cine-MRI 在 CIPO 患者中的临床应用价值。cine-MRI 清楚地检测到 CIPO 患者的收缩功能障碍。cine-MRI 是一种非侵入性、无辐射的方法，可以直接评估整个小肠蠕动，并可以一目了然地检测到受影响的肠段；因此，它可能在临床实践中对 CIPO 患者的诊断和随访非常有用。
