Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Germany.
Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Germany.
Eur J Radiol. 2020 Nov;132:109265. doi: 10.1016/j.ejrad.2020.109265. Epub 2020 Sep 12.
To investigate imaging findings of esophageal motility disorders on dynamic real-time.
102 patients with GERD-like symptoms were included in this retrospective study between 2015-2018. Dynamic real-time MRI visualized the transit of a 10 mL pineapple juice bolus through the esophagus and EGJ with a temporal resolution of 40 ms. Dynamic and anatomic parameters were measured by consensus reading. Imaging findings were compared to HRM utilizing the Chicago classification of esophageal motility disorders, v3.0.
All 102 patients completed real-time MRI in a median examination time of 15 min. On HRM, 14 patients presented with disorders with EGJ outlet obstruction (EGJOO) (13.7 %), 7 patients with major disorders of peristalsis (6.9 %), and 32 patients with minor disorders of peristalsis (31.4 %). HRM was normal in 49 patients (48.0 %). Incomplete bolus clearance was significantly more frequent in patients with esophageal motility disorders on HRM than in patients with normal HRM (p = 0.0002). In patients with motility disorders with EGJOO and major disorders of peristalsis, the esophageal diameter tended to be wider (23.6 ± 8.0 vs. 21.2 ± 3.5 mm, p = 0.089) and the sphincter length longer (19.7 ± 7.3 vs. 16.7 ± 3.0 mm, p = 0.091) compared to patients with normal HRM. 3/7 patients with achalasia type II were correctly identified by real-time MRI and one further achalasia type II patient was diagnosed with a motility disorder on MRI films. The other 3/7 patients presented no specific imaging features.
Real-time MRI is an auxiliary diagnostic tool for the assessment of swallowing events. Imaging parameters may assist in the detection of esophageal motility disorders.
研究动态实时食管动力障碍的影像学表现。
本回顾性研究纳入了 2015-2018 年间 102 例 GERD 样症状患者。动态实时 MRI 以 40ms 的时间分辨率可视化 10ml 菠萝汁团通过食管和食管下括约肌的转运。通过共识阅读测量动态和解剖参数。将影像学结果与利用食管动力障碍芝加哥分类 v3.0 的 HRM 进行比较。
所有 102 例患者均在 15 分钟的中位检查时间内完成实时 MRI。在 HRM 上，14 例患者存在食管下括约肌出口梗阻（EGJOO）障碍（13.7%），7 例存在主要蠕动障碍（6.9%），32 例存在次要蠕动障碍（31.4%）。49 例 HRM 正常（48.0%）。在 HRM 存在食管动力障碍的患者中，不完全清除食团的频率明显高于 HRM 正常的患者（p=0.0002）。在存在 EGJOO 和主要蠕动障碍的运动障碍患者中，食管直径趋于更宽（23.6±8.0 与 21.2±3.5mm，p=0.089），括约肌长度更长（19.7±7.3 与 16.7±3.0mm，p=0.091）与 HRM 正常的患者相比。实时 MRI 正确识别出 7 例 II 型贲门失弛缓症中的 3 例，另 1 例 II 型贲门失弛缓症患者在 MRI 片上被诊断为运动障碍。其他 3/7 例患者没有特定的影像学特征。
实时 MRI 是评估吞咽事件的辅助诊断工具。影像学参数可能有助于检测食管动力障碍。
