Diagnostic value of combining ultrafast cine MRI and morphological measurements on gastroesophageal reflux disease

Abstract

Purpose

To evaluate the diagnostic performance of combining ultrafast real-time cine MRI with morphological measurements on gastroesophageal reflux disease (GERD).

Methods

In the prospective study, 40 healthy volunteers and 30 GERD patients underwent real-time cine MRI using an undersampled low-angle gradient echo sequence (50 ms/frame) with deep-learning reconstruction, to monitor the gastroesophageal junction (GEJ) and observe the reflux of the contrast agent during the Valsalva maneuver. The width of the lower esophagus, the length of the lower esophageal sphincter (LES), the end-expiratory and post Valsalva maneuver His angle were measured.

Results

There were no statistical differences between the two group either in lower esophageal width (14.06 ± 1.50 mm vs. 14.75 ± 1.57 mm, P > 0.05) or LES length (25.20 ± 1.46 mm vs. 24.39 ± 1.68 mm, P > 0.05). The end-expiratory His angle (84.45 ± 18.67°) and post Valsalva maneuver His angle (101.53 ± 19.22°), and the differences between them (17.08 ± 5.65°) in the GERD group were greater than those in the healthy volunteers (71.51 ± 18.01°, 86.09 ± 18.24°, 14.57 ± 3.88° respectively, P < 0.05). Reflux was induced in 8 cases of GERD group including 4 cases with hiatus hernia and not observed in healthy volunteers. The AUC for diagnosing GERD were 0.702, 0.737 and 0.634 for end-expiratory, post Valsalva maneuver His angle and their differences, when combined with real-time MRI was 0.823, with a sensitivity of 86.67% and a specificity of 67.50%.

Conclusion

Real-time MRI can display dynamic swallowing and reflux at the GEJ. The His angle can serve as a morphological indicator for diagnosing GERD with MRI.

Graphical Abstract