Department of Diagnostic and Interventional Radiology, University Medical Center, Göttingen, 37075, Germany.
Department of Diagnostic and Interventional Radiology, University Medical Center, Göttingen, 37075, Germany.
Eur J Radiol. 2020 Apr;125:108856. doi: 10.1016/j.ejrad.2020.108856. Epub 2020 Jan 29.
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.
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.
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).
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.
与 pH 测量和阻抗相比，评估实时 MRI 动态评估 GERD（胃食管反流病）样症状患者胃食管反流的诊断潜力。
本回顾性研究纳入了 2015 年至 2018 年间接受实时 MRI 和 pH 测量的患者。3T 下的实时 MRI 通过欠采样径向 FLASH 采集和 NLINV 迭代图像重建来实现。实时 MRI 可视化了菠萝汁通过胃食管交界处的传输以及在瓦尔萨尔瓦动作期间的传输。将 MRI 结果与 24 小时 pH 测量进行比较，以评估酸性反流（遵循里昂共识指南），并与阻抗测量评估非酸性反流。选择标准的 2×2 表来计算诊断性能。
91/93 名符合条件的患者符合纳入标准（男性 n=49；女性 n=42；中位年龄 55 岁）。所有 MRI 研究均成功完成，平均检查时间为 15 分钟，无不良事件发生。在实时 MRI 上，60 名患者（66%）有反流，41 名患者（45%）pH 测量有反流，54 名患者（59%）阻抗测量有反流。与 pH 测量和阻抗相比，实时 MRI 的敏感性为 0.78（95%CI：0.66-0.87），特异性为 0.67（95%CI：0.45-0.84），阳性预测值为 0.87（95%CI：0.75-0.94）。
实时 MRI 是一种评估 GERD 样症状患者胃食管反流的影像学方法。考虑到其高阳性预测值，实时 MRI 可以准确识别出需要进一步进行 pH 测量和阻抗检查的患者。
