Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, 37075, Göttingen, Germany.
Biomedical NMR, Max-Planck-Institute for Biophysical Chemistry, Göttingen, Germany.
Eur Radiol. 2019 Sep;29(9):4691-4698. doi: 10.1007/s00330-019-06025-x. Epub 2019 Feb 25.
To assess the diagnostic potential of dynamic real-time MRI for fundoplication failure in patients with persistent or recurrent GERD-like (gastroesophageal reflux disease) complaints.
Twenty-two consecutive patients (male n = 11; female n = 11; median age 59 years) with recurrent or persistent GERD-like symptom after fundoplication were enrolled between 2015 and 2017. Median duration of GERD-like symptoms was 21 months. Real-time MRI (3 Tesla) was performed at 40 ms temporal resolution using undersampled radial fast low-angle shot acquisitions with nonlinear inverse image reconstruction. MRI movies dynamically visualized bolus transit of pineapple juice through the gastroesophageal junction, position of the fundoplication wrap and recurring hernia or reflux during Valsalva maneuver. MRI results were compared to endoscopic findings.
Real-time MRI was successfully completed in all patients without adverse events (average examination time 15 min). Morphological correlates for GERD-like symptoms were evident in 20 patients (90.1%) with gastric reflux in 19 cases. Nine patients (40.1%) had wrap disruption and recurrent gastric hernia. Wrap migration or telescoping hernia was detected in nine patients (40.1%). One patient presented with continued reflux despite intact fundoplication wrap. Esophageal dysmotility with delayed bolus passage was observed in one case. On endoscopy, gastric hernia or wrap disruption was diagnosed in seven cases, and esophagitis or Barret's metaplasia in nine cases.
Real-time MRI is a fast and safe modality for dynamic imaging after fundoplication, without radiation exposure or administration of gadolinium-based contrast media. In a relevant number of cases, real-time MRI reveals correlates for GERD-like symptoms.
• Real-time MRI reliably visualizes the gastroesophageal junction after fundoplication surgery. • Patients with recurring GERD-like symptoms have a high rate of morphological failure patterns that can be identified by real-time MRI. • Dynamic assessment of gastroesophageal junction by real-time MRI is a perspective diagnostic tool for detection of fundoplication failure.
评估动态实时 MRI 在胃食管反流病（GERD）样持续性或复发性食管反流病（GERD）患者中胃底折叠术失败的诊断潜力。
2015 年至 2017 年间，共纳入 22 例胃底折叠术后出现复发性或持续性 GERD 样症状的连续患者（男 11 例；女 11 例；中位年龄 59 岁）。GERD 样症状的中位持续时间为 21 个月。使用非线性逆图像重建的欠采样径向快速低角度 shot 采集，以 40ms 的时间分辨率进行实时 MRI（3 Tesla）。MRI 电影动态可视化菠萝汁通过食管胃交界处的转运、胃底折叠包裹的位置以及 Valsalva 动作期间复发的疝或反流。将 MRI 结果与内镜检查结果进行比较。
所有患者均成功完成实时 MRI，无不良事件（平均检查时间 15 分钟）。20 例患者（90.1%）出现 GERD 样症状的形态学相关表现，19 例存在胃反流。9 例（40.1%）有包裹破裂和复发性胃疝。在 9 例（40.1%）患者中检测到包裹迁移或套叠疝。1 例患者尽管胃底折叠包裹完整，但仍存在持续反流。1 例患者存在食管动力障碍，表现为延迟的食团通过。内镜检查诊断 7 例胃疝或包裹破裂，9 例食管炎或 Barrett 化生。
实时 MRI 是一种快速、安全的胃底折叠术后动态成像方式，无辐射暴露或钆基对比剂给药。在相当数量的病例中，实时 MRI 显示与 GERD 样症状相关的表现。
实时 MRI 可靠地可视化胃底折叠术后的食管胃连接处。
出现复发性 GERD 样症状的患者有很高的形态学失败模式发生率，可通过实时 MRI 识别。
实时 MRI 对食管胃交界处进行动态评估是一种有前景的检测胃底折叠术失败的诊断工具。
