Assessment of Small Bowel Motility Using Cine-magnetic Resonance Imaging in Patients Suspected With Chronic Intestinal Pseudo-obstruction.

Background/aims: Chronic intestinal pseudo-obstruction (CIPO), characterized by dilated small or large intestine on CT, has a high postoperative recurrence rate. In contrast, focal hypoganglionosis with adult-onset megacolon (FHAM) generally shows a good postoperative prognosis. This study aims to evaluate the utility of cine-MRI in differentiating between these 2 diseases by assessing small bowel (SB) motility and its correlation with clinical outcomes.

Methods: The clinical features and outcomes of 41 prospectively enrolled patients suspected of having CIPO who underwent cine-MRI were reviewed. Multi-slice cine-MRI was conducted.

Results: Of 41 patients suspected of having CIPO, 17 showed SB dilatation on CT, while 24 did not. According to cine-MRI, 3 exhibited decreased SB motility, while 38 showed no motility reduction. Among the 17 patients with dilated SB on CT, only 3 demonstrated decreased SB motility on cine-MRI. By contrast, all patients with nondilated SB on CT exhibited normal SB motility on cine-MRI. Patients with decreased SB motility showed a higher rate of postoperative disease recurrence (P = 0.011) and continuation of medication after surgery (P = 0.020) than in those with normal SB motility.

Conclusions: Cine-MRI is useful in assessing SB motility that cannot be detected on CT. Its usefulness extends to aiding surgical decision-making, particularly in differentiating between FHAM and CIPO.