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Choi JY, Yun J, Heo S, Kim DW, Choi SH, Yoon J, Kim K, Jung KW, Myung SJ. Technical Feasibility of Quantitative Measurement of Various Degrees of Small Bowel Motility Using Cine Magnetic Resonance Imaging. Korean J Radiol 2023; 24:1093-1101. [PMID: 37724587 PMCID: PMC10613842 DOI: 10.3348/kjr.2023.0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/18/2023] [Accepted: 08/01/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE Cine magnetic resonance imaging (MRI) has emerged as a noninvasive method to quantitatively assess bowel motility. However, its accuracy in measuring various degrees of small bowel motility has not been extensively evaluated. We aimed to draw a quantitative small bowel motility score from cine MRI and evaluate its performance in a population with varying degrees of small bowel motility. MATERIALS AND METHODS A total of 174 participants (28.5 ± 7.6 years; 135 males) underwent a 22-second-long cine MRI sequence (2-dimensional balanced turbo-field echo; 0.5 seconds per image) approximately 5 minutes after being intravenously administered 10 mg of scopolamine-N-butyl bromide to deliberately create diverse degrees of small bowel motility. In a manually segmented area of the small bowel, motility was automatically quantified using a nonrigid registration and calculated as a quantitative motility score. The mean value (MV) of motility grades visually assessed by two radiologists was used as a reference standard. The quantitative motility score's correlation (Spearman's ρ) with the reference standard and performance (area under the receiver operating characteristics curve [AUROC], sensitivity, and specificity) for diagnosing adynamic small bowel (MV of 1) were evaluated. RESULTS For the MV of the quantitative motility scores at grades 1, 1.5, 2, 2.5, and 3, the mean ± standard deviation values were 0.019 ± 0.003, 0.027 ± 0.010, 0.033 ± 0.008, 0.032 ± 0.009, and 0.043 ± 0.013, respectively. There was a significant positive correlation between the quantitative motility score and the MV (ρ = 0.531, P < 0.001). The AUROC value for diagnosing a MV of 1 (i.e., adynamic small bowel) was 0.953 (95% confidence interval, 0.923-0.984). Moreover, the optimal cutoff for the quantitative motility score was 0.024, with a sensitivity of 100% (15/15) and specificity of 89.9% (143/159). CONCLUSION The quantitative motility score calculated from a cine MRI enables diagnosis of an adynamic small bowel, and potentially discerns various degrees of bowel motility.
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Affiliation(s)
- Ji Young Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jihye Yun
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Subin Heo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Dong Wook Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Sang Hyun Choi
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jiyoung Yoon
- Department of Gastroenterology, Uijeongbu Eulji Medical Center, Uijeongbu, Republic of Korea
| | - Kyuwon Kim
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kee Wook Jung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Jae Myung
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Chacon MA, Wilson NA. The Challenge of Small Intestine Length Measurement: A Systematic Review of Imaging Techniques. J Surg Res 2023; 290:71-82. [PMID: 37210758 PMCID: PMC10330168 DOI: 10.1016/j.jss.2023.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/22/2023] [Accepted: 04/15/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Short bowel syndrome is the most common cause of intestinal failure, with morbidity and mortality linked to remanent small intestine length. There is no current standard for noninvasive bowel length measurement. MATERIALS AND METHODS The literature was systematically searched for articles describing measurements of small intestine length from radiographic studies. Inclusion required reporting intestinal length as an outcome and use of diagnostic imaging for length assessment compared to a ground truth. Two reviewers independently screened studies for inclusion, extracted data, and assessed study quality. RESULTS Eleven studies met the inclusion criteria and reported small intestinal length measurement using four imaging modalities: barium follow-through, ultrasound, computed tomography, and magnetic resonance. Five barium follow-through studies reported variable correlations with intraoperative measurements (r = 0.43-0.93); most (3/5) reported underestimation of length. US studies (n = 2) did not correlate with ground truths. Two computed tomography studies reported moderate-to-strong correlations with pathologic (r = 0.76) and intraoperative measurements (r = 0.99). Five studies of magnetic resonance showed moderate-to-strong correlations with intraoperative or postmortem measurements (r = 0.70-0.90). Vascular imaging software was used in two studies, and a segmentation algorithm was used for measurements in one. CONCLUSIONS Noninvasive measurement of small intestine length is challenging. Three-dimensional imaging modalities reduce the risk of length underestimation, which is common with two-dimensional techniques. However, they also require longer times to perform length measurements. Automated segmentation has been trialed for magnetic resonance enterography, but this method does not translate directly to standard diagnostic imaging. While three-dimensional images are most accurate for length measurement, they are limited in their ability to measure intestinal dysmotility, which is an important functional measure in patients with intestinal failure. Future work should validate automated segmentation and measurement software using standard diagnostic imaging protocols.
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Affiliation(s)
- Miranda A Chacon
- Department of Surgery, University of Rochester Medical Center, Rochester, New York
| | - Nicole A Wilson
- Division of Pediatric Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York; Department of Biomedical Engineering, University of Rochester, Rochester, New York.
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Kitazume Y, Takenaka K, Ohtsuka K, Ozawa Y, Kimura K, Watanabe R, Tsuchiya J, Fujii T, Nagahori M, Watanabe M, Tateishi U. Motility Mapping Quantification Using the Classical Optical Flow Algorithm for Small Bowel Crohn's Disease: Comparison with Balloon-assisted Enteroscopy Findings. Magn Reson Med Sci 2023; 22:325-334. [PMID: 35545505 PMCID: PMC10449560 DOI: 10.2463/mrms.mp.2021-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/05/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To quantify bowel motility shown on cine MRI using the classical optical flow algorithm and compare it with balloon-assisted enteroscopy (BAE) findings in patients with Crohn's disease (CD). METHODS This retrospective study included 29 consecutive patients with CD who had undergone MR enterocolonography (MREC) and BAE between March and May 2017. We developed computer software to present motion vector magnitudes between consecutive cine MR images as bowel motility maps via a classical optical flow algorithm using the Horn-Schunck method. Cine MR images were acquired with a balanced steady-state free precession sequence in the coronal direction to capture small bowel motility. The small bowels were divided into three segments. In total, 63 bowel segments were assessed via BAE and MREC. Motility scores on the maps, simplified MR index of activity (sMaRIA), and MREC score derived from a 5-point MR classification were assessed independently by two radiologists and compared with the CD endoscopic index of severity (CDEIS). Correlations were assessed using Spearman's rank coefficient. The areas under the receiver-operating characteristic curve (AUCs) of motility score for differentiating CDEIS was calculated; a P value < 0.05 was considered statistically significant. RESULTS Motility score was negatively correlated with CDEIS (r = -0.59 [P < 0.001] and -0.54 [P < 0.001]), and the AUCs of motility scores for detecting CDEIS ≥ 3 were 88.2% and 78.6% for observers 1 and 2, respectively. There were no significant differences in the AUC for detecting CDEIS ≥ 3 and CDEIS ≥ 12 between motility and sMaRIA or MREC score. CONCLUSION The motility map was feasible for locally quantifying the bowel motility. In addition, the motility score on the map reflected the endoscopic inflammatory activity of each small bowel segment in patients with CD; hence, it could be used as a tool in objectively interpreting cine MREC to predict inflammatory activity in CD.
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Affiliation(s)
- Yoshio Kitazume
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kento Takenaka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kazuo Ohtsuka
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuo Ozawa
- Systems Laboratories Corporation, Yokohama, Kanagawa, Japan
| | - Koichiro Kimura
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryosuke Watanabe
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masakazu Nagahori
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mamoru Watanabe
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Tokyo, Japan
- TMDU Advanced Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Grassi G, Laino ME, Fantini MC, Argiolas GM, Cherchi MV, Nicola R, Gerosa C, Cerrone G, Mannelli L, Balestrieri A, Suri JS, Carriero A, Saba L. Advanced imaging and Crohn’s disease: An overview of clinical application and the added value of artificial intelligence. Eur J Radiol 2022; 157:110551. [DOI: 10.1016/j.ejrad.2022.110551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/23/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022]
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Colonic Function Investigations in Children: Review by the ESPGHAN Motility Working Group. J Pediatr Gastroenterol Nutr 2022; 74:681-692. [PMID: 35262513 DOI: 10.1097/mpg.0000000000003429] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Disorders of colonic motility, most often presenting as constipation, comprise one of the commonest causes of outpatient visits in pediatric gastroenterology. This review, discussed and created by the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Motility Working Group, is a practical guide, which highlights the recent advances in pediatric colonic motility testing including indications, technical principles of the tests, patient preparation, performance and basis of the results' analysis of the tests. classical methods, such as colonic transit time (cTT) with radiopaque markers and colonic scintigraphy, as well as manometry and novel techniques, such as wireless motility capsule and electromagnetic capsule tracking systems are discussed.
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A Potential Role for Bile Acid Signaling in Celiac Disease-Associated Fatty Liver. Metabolites 2022; 12:metabo12020130. [PMID: 35208205 PMCID: PMC8879761 DOI: 10.3390/metabo12020130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023] Open
Abstract
Celiac disease (CeD) is a chronic autoimmune disorder characterized by an intolerance to storage proteins of many grains. CeD is frequently associated with liver damage and steatosis. Bile acid (BA) signaling has been identified as an important mediator in gut–liver interaction and the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Here, we aimed to analyze BA signaling and liver injury in CeD patients. Therefore, we analyzed data of 20 CeD patients on a gluten-free diet compared to 20 healthy controls (HC). We furthermore analyzed transaminase levels, markers of cell death, BA, and fatty acid metabolism. Hepatic steatosis was determined via transient elastography, by MRI and non-invasive scores. In CeD, we observed an increase of the apoptosis marker M30 and more hepatic steatosis as compared to HC. Fibroblast growth factor 19 (FGF19) was repressed in CeD, while low levels were associated with steatosis, especially in patients with high levels of anti-tissue transglutaminase antibodies (anti-tTG). When comparing anti-tTG-positive CeD patients to individuals without detectable anti-tTG levels, hepatic steatosis was accentuated. CeD patients with significant sonographic steatosis (defined by CAP ≥ 283 db/m) were exclusively anti-tTG-positive. In summary, our results suggest that even in CeD patients in clinical remission under gluten-free diet, alterations in gut–liver axis, especially BA signaling, might contribute to steatotic liver injury and should be further addressed in future studies and clinical practice.
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Arkko A, Kaseva T, Salli E, Mäkelä T, Savolainen S, Kangasniemi M. Automatic detection of Crohn's disease using quantified motility in magnetic resonance enterography: initial experiences. Clin Radiol 2021; 77:96-103. [PMID: 34753588 DOI: 10.1016/j.crad.2021.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/06/2021] [Indexed: 12/13/2022]
Abstract
AIM To report initial experiences of automatic detection of Crohn's disease (CD) using quantified motility in magnetic resonance enterography (MRE). MATERIALS AND METHODS From 302 patients, three datasets with roughly equal proportions of CD and non-CD cases with various illnesses were drawn for testing and neural network training and validation. All datasets had unique MRE parameter configurations and were performed in free breathing. Nine neural networks were devised for automatic generation of three different regions of interests (ROI): small bowel, all bowel, and non-bowel. Additionally, a full-image ROI was tested. The motility in an MRE series was quantified via a registration procedure, which, accompanied with given ROIs, resulted in three motility indices (MI). A subset of the indices was used as an input for a binary logistic regression classifier, which predicted whether the MRE series represented CD. RESULTS The highest mean area under the curve (AUC) score, 0.78, was reached using the full-image ROI and with the dataset with the highest cine series length. The best AUC scores for the other two datasets were only 0.54 and 0.49. CONCLUSION The automatic system was able to detect CD in the group of MRE studies with lower temporal resolution and longer cine series showing potential in primary bowel disorder diagnostics. Larger ROI selections and utilising all available cine series for motility registration yielded slight performance improvements.
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Affiliation(s)
- A Arkko
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, FI-00290, Helsinki, Finland.
| | - T Kaseva
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, FI-00290, Helsinki, Finland
| | - E Salli
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, FI-00290, Helsinki, Finland
| | - T Mäkelä
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, FI-00290, Helsinki, Finland; Department of Physics, University of Helsinki, P.O. Box 64, FI-00014, Helsinki, Finland
| | - S Savolainen
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, FI-00290, Helsinki, Finland; Department of Physics, University of Helsinki, P.O. Box 64, FI-00014, Helsinki, Finland
| | - M Kangasniemi
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital and University of Helsinki, P.O. Box 340, FI-00290, Helsinki, Finland
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Manka P, Sydor S, Wase N, Best J, Brandenburg M, Hellbeck A, Schänzer J, Vilchez-Vargas R, Link A, Figge A, Jähnert A, von Arnim U, Coombes JD, Cubero FJ, Kahraman A, Kim MS, Kälsch J, Kinner S, Faber KN, Moshage H, Gerken G, Syn WK, Friedman SL, Canbay A, Bechmann LP. Anti-TNFα treatment in Crohn's disease: Impact on hepatic steatosis, gut-derived hormones and metabolic status. Liver Int 2021; 41:2646-2658. [PMID: 34219348 DOI: 10.1111/liv.15003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIMS An association between Crohn's disease (CD) and hepatic steatosis has been reported. However, the underlying mechanisms of steatosis progression in CD are not clear. Among the most effective CD treatments are agents that inhibit Tumor-Necrosis-Factor (TNF) activity, yet it is unclear why anti-TNFα agents would affect steatosis in CD. Recent studies suggest that microbiome can affect both, CD and steatosis pathogenesis. Therefore, we here analysed a potential relationship between anti-TNF treatment and hepatic steatosis in CD, focusing on the gut-liver axis. METHODS This cross-sectional study evaluated patients with established CD, with and without anti-TNFα treatment, analysing serum markers of liver injury, measurement of transient elastography, controlled attenuation parameter (CAP) and MRI for fat detection. Changes in lipid and metabolic profiles were assessed by serum and stool lipidomics and metabolimics. Additionally, we analysed gut microbiota composition and mediators of bile acid (BA) signalling via stool and serum analysis. RESULTS Patients on anti-TNFα treatment had less hepatic steatosis as assessed by CAP and MRI. Serum FGF19 levels were significantly higher in patients on anti-TNFα therapy and associate with reduced steatosis and increased bowel motility. Neutral lipids including triglycerides were reduced in the serum of patients on anti-TNF treatment. Bacteria involved in BA metabolism and FGF19 regulation, including Firmicutes, showed group-specific alterations with low levels in patients without anti-TNFα treatment. Low abundance of Firmicutes was associated with higher triglyceride levels. CONCLUSIONS Anti-TNFα treatment is associated with reduced steatosis, lower triglyceride levels, alterations in FXR-signalling (eg FGF19) and microbiota composition in CD.
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Affiliation(s)
- Paul Manka
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany.,Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Svenja Sydor
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Nishikant Wase
- Biomolecular Analysis Facility, University of Virginia, School of Medicine, Charlottesville, VA, USA
| | - Jan Best
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Malte Brandenburg
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Annika Hellbeck
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Julia Schänzer
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Ramiro Vilchez-Vargas
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke-University Hospital Magdeburg, Magdeburg, Germany
| | - Alexander Link
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke-University Hospital Magdeburg, Magdeburg, Germany
| | - Anja Figge
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Andreas Jähnert
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke-University Hospital Magdeburg, Magdeburg, Germany
| | - Jason D Coombes
- Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Francisco-Javier Cubero
- Department of Immunology, Ophthalmology and ORL, Complutense University School of Medicine, Madrid, Spain.,12 de Octubre Health Research Institute (imas 12), Madrid, Spain
| | - Alisan Kahraman
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Moon-Sung Kim
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Julia Kälsch
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Klaas-Nico Faber
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Han Moshage
- Department of Gastroenterology and Hepatology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Guido Gerken
- Department of Gastroenterology and Hepatology, University Hospital Essen, Essen, Germany
| | - Wing-Kin Syn
- Division of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.,Section of Gastroenterology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA.,Department of Physiology, Faculty of Medicine and Nursing, University of Basque Country UPV/EHU, Vizcaya, Spain
| | - Scott L Friedman
- Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ali Canbay
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
| | - Lars P Bechmann
- Department of Internal Medicine, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, Bochum, Germany
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Tufvesson H, Dreja J, Ekberg O, Leander P, Månsson S, Ohlsson B. Quantified small bowel motility in patients with ulcerative colitis and gastrointestinal symptoms: a pilot study. Acta Radiol 2021; 62:858-866. [PMID: 32806922 DOI: 10.1177/0284185120946713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastrointestinal (GI) symptoms are common in patients with ulcerative colitis (UC), even when the disease is in remission, possibly due to abnormalities in GI motility. Small bowel motility can be assessed globally and in specific intestinal regions during magnetic resonance enterography (MRE) using a displacement mapping technique. PURPOSE To investigate whether small bowel motility in MRE differs between patients with UC and controls, and if altered motility correlates with GI symptoms. MATERIAL AND METHODS In 2016-2018, patients who were admitted for MRE, regardless of clinical indication, were consecutively invited to the study. Healthy volunteers were recruited. The participants completed a questionnaire regarding GI symptoms and relevant clinical data were reviewed in the medical records. The dynamic imaging series obtained during MRE were sent for motility mapping and a motility index (MI) was calculated in jejunum, ileum and terminal ileum in all participants. RESULTS In total, 224 patients and healthy volunteers were enrolled in the study. Fifteen were diagnosed with UC and 22 were considered healthy controls. In UC, the prevalence of GI symptoms was higher than in controls (P < 0.001), both in remission and in active disease. There was no correlation between GI symptoms and small bowel motility in UC. Jejunal motility was lower in UC than in controls (P = 0.049). CONCLUSION Jejunal motility is decreased in UC compared with healthy controls, but there is no relationship between small bowel motility and GI symptoms in UC.
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Affiliation(s)
- Hanna Tufvesson
- Department of Gastroenterology and Hepatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Julia Dreja
- Department of Internal Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Olle Ekberg
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Peter Leander
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Sven Månsson
- Department of Translational Medicine, Medical Radiation Physics, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Bodil Ohlsson
- Department of Internal Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
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Abstract
ABSTRACT In this review article, we present the latest developments in quantitative imaging biomarkers based on magnetic resonance imaging (MRI), applied to the diagnosis, assessment of response to therapy, and assessment of prognosis of Crohn disease. We also discuss the biomarkers' limitations and future prospects. We performed a literature search of clinical and translational research in Crohn disease using diffusion-weighted MRI (DWI-MRI), dynamic contrast-enhanced MRI (DCE-MRI), motility MRI, and magnetization transfer MRI, as well as emerging topics such as T1 mapping, radiomics, and artificial intelligence. These techniques are integrated in and combined with qualitative image assessment of magnetic resonance enterography (MRE) examinations. Quantitative MRI biomarkers add value to MRE qualitative assessment, achieving substantial diagnostic performance (area under receiver-operating curve = 0.8-0.95). The studies reviewed show that the combination of multiple MRI sequences in a multiparametric quantitative fashion provides rich information that may help for better diagnosis, assessment of severity, prognostication, and assessment of response to biological treatment. However, the addition of quantitative sequences to MRE examinations has potential drawbacks, including increased scan time and the need for further validation before being used in therapeutic drug trials as well as the clinic.
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Barten DLJ, Laan JJ, Nelissen KJ, Visser J, Westerveld H, Bel A, de Jonge CS, Stoker J, van Kesteren Z. A 3D cine-MRI acquisition technique and image analysis framework to quantify bowel motion demonstrated in gynecological cancer patients. Med Phys 2021; 48:3109-3119. [PMID: 33738805 PMCID: PMC8360025 DOI: 10.1002/mp.14851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/01/2021] [Accepted: 03/05/2021] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI) is increasingly used in radiation oncology for target delineation and radiotherapy treatment planning, for example, in patients with gynecological cancers. As a consequence of pelvic radiotherapy, a part of the bowel is irradiated, yielding risk of bowel toxicity. Existing dose-effect models predicting bowel toxicity are inconclusive and bowel motion might be an important confounding factor. The exact motion of the bowel and dosimetric effects of its motion are yet uncharted territories in radiotherapy. In diagnostic radiology methods on the acquisition of dynamic MRI sequences were developed for bowel motility visualization and quantification. Our study aim was to develop an imaging technique based on three-dimensional (3D) cine-MRI to visualize and quantify bowel motion and demonstrate it in a cohort of gynecological cancer patients. METHODS We developed an MRI acquisition suitable for 3D bowel motion quantification, namely a balanced turbo field echo sequence (TE = 1.39 ms, TR = 2.8 ms), acquiring images in 3.7 s (dynamic) with a 1.25 × 1.25 × 2.5 mm3 resolution, yielding a field of view of 200 × 200 × 125 mm3 . These MRI bowel motion sequences were acquired in 22 gynecological patients. During a 10-min scan, 160 dynamics were acquired. Subsequent dynamics were deformably registered using a B-spline transformation model, resulting in 159 3D deformation vector fields (DVFs) per MRI set. From the 159 DVFs, the average vector length was calculated per voxel to generate bowel motion maps. Quality assurance was performed on all 159 DVFs per MRI, using the Jacobian Determinant and the Harmonic Energy as deformable image registration error metrics. In order to quantify bowel motion, we introduced the concept of cumulative motion-volume histogram (MVH) of the bowel bag volume. Finally, interpatient variation of bowel motion was analyzed using the MVH parameters M10%, M50%, and M90%. The M10%/M50%/M90% represents the minimum bowel motion per frame of 10%/50%/90% of the bowel bag volume. RESULTS The motion maps resulted in a visualization of areas with small and large movements within the bowel bag. After applying quality assurance, the M10%, M50%, and M90% were 4.4 (range 2.2-7.6) mm, 2.2 (range 0.9-4.1) mm, and 0.5 (range 0.2-1.4) mm per frame, on average over all patients, respectively. CONCLUSION We have developed a method to visualize and quantify 3D bowel motion with the use of bowel motion specific MRI sequences in 22 gynecological cancer patients. This 3D cine-MRI-based quantification tool and the concept of MVHs can be used in further studies to determine the effect of radiotherapy on bowel motion and to find the relation with dose effects to the small bowel. In addition, the developed technique can be a very interesting application for bowel motility assessment in diagnostic radiology.
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Affiliation(s)
- Danique L J Barten
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Janna J Laan
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Koen J Nelissen
- Department of Radiation Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Jorrit Visser
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Henrike Westerveld
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Arjan Bel
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Catharina S de Jonge
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Zdenko van Kesteren
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
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12
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Menys A, Hoad C, Spiller R, Scott SM, Atkinson D, Marciani L, Taylor SA. Spatio-temporal motility MRI analysis of the stomach and colon. Neurogastroenterol Motil 2019; 31:e13557. [PMID: 30821098 DOI: 10.1111/nmo.13557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/26/2018] [Accepted: 01/01/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND MRI is increasingly used to objectively assess gastrointestinal motility. However, motility metrics often do not offer insights into the nature of contractile action. This study introduces a systematic method of making spatio-temporal measurements of contractions, based on changes in bowel lumen diameter. METHODS Two heterogeneous cohorts of subjects were selected displaying gastric (n = 15) and colonic motility (n = 20) on which to test the spatio-temporal motility MRI (STMM) technique. STMM involved delineating the bowel lumen along with inner and outer bowel wall along a section of the gastrointestinal tract. A series of diameter measurements were made automatically across the central axis of the lumen. Measurements were automatically propagated through the time series using a previously validated algorithm. Contractions were quantitatively summarized with two methods measuring (a) normalized contraction plot (NCP) and (b) combined velocity distance (CVD) both of which can be visualized as spatio-temporal motility maps. Both metrics were correlated against subjective visual scoring systems. KEY RESULTS Good correlation was seen between reader scores and both motility metrics (NCP, R = 0.85, P < 0.001, CVD, R = 0.93, R < 0.001) in the gastric data. Good correlation was also seen between the reader scores and the two metrics in the colonic data (NCP, R = 0.82, P < 0.001, CVD, R = 0.78, R < 0.001). CONCLUSIONS AND INFERENCES Spatio-temporal motility MRI analysis of the stomach and colon correlates well with reader scores in a range of datasets and provides both a quantitative and qualitative means of assessing contractile activity in the gastrointestinal tract.
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Affiliation(s)
- Alex Menys
- Centre for Medical Imaging, UCL, London, UK
| | - Caroline Hoad
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Robin Spiller
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - S Mark Scott
- Wingate Centre for Neurogastroenterology, Blizard Institute, QMUL, London, UK
| | | | - Luca Marciani
- Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
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13
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Sturm A, Maaser C, Calabrese E, Annese V, Fiorino G, Kucharzik T, Vavricka SR, Verstockt B, van Rheenen P, Tolan D, Taylor SA, Rimola J, Rieder F, Limdi JK, Laghi A, Krustiņš E, Kotze PG, Kopylov U, Katsanos K, Halligan S, Gordon H, González Lama Y, Ellul P, Eliakim R, Castiglione F, Burisch J, Borralho Nunes P, Bettenworth D, Baumgart DC, Stoker J. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 2: IBD scores and general principles and technical aspects. J Crohns Colitis 2019; 13:273-284. [PMID: 30137278 DOI: 10.1093/ecco-jcc/jjy114] [Citation(s) in RCA: 215] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Andreas Sturm
- Department of Gastroenterology, DRK Kliniken Berlin I Westend, Berlin, Germany
| | - Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Emma Calabrese
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic & American Hospital, Dubai, UAE
| | - Gionata Fiorino
- Department of Gastroenterology, Humanitas Clinical and Research Institute, Milan, Italy
| | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | | | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven and CHROMETA - Translational Research in Gastrointestinal Disorders, KU Leuven, Belgium
| | - Patrick van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen, The Netherlands
| | - Damian Tolan
- Clinical Radiology, St James's University Hospital, Leeds, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester; Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Andrea Laghi
- Department of Clinical and Surgical Translational Medicine, Sapienza - University of Rome, Rome, Italy
| | - Eduards Krustiņš
- Department of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Paulo G Kotze
- Colorectal Surgery Unit, Catholic University of Paraná PUCPR, Curitiba, Brazil
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Hannah Gordon
- Section of Gastroenterology & Hepatology, Royal London Hospital, London, UK
| | - Yago González Lama
- Department of Gastroenterology, University Hospital Puerta De Hierro, Majadahonda Madrid, Spain
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Paula Borralho Nunes
- Department of Anatomic Pathology, Hospital Cuf Descobertas; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center AMC, University of Amsterdam, Amsterdam, The Netherlands
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14
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Evaluation of compressed sensing MRI for accelerated bowel motility imaging. Eur Radiol Exp 2019; 3:7. [PMID: 30725241 PMCID: PMC6365583 DOI: 10.1186/s41747-018-0079-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/20/2018] [Indexed: 11/13/2022] Open
Abstract
Background To investigate the feasibility of compressed sensing and parallel imaging (CS-PI)-accelerated bowel motility magnetic resonance imaging (MRI) and to compare its image quality and diagnostic quality to conventional sensitivity encoding (SENSE) accelerated scans. Methods Bowel MRI was performed in six volunteers using a three-dimensional balanced fast field-echo sequence. Static scans were performed after the administration of a spasmolytic agent to prevent bowel motion artefacts. Fully sampled reference scans and multiple prospectively 3× to 7× undersampled CS-PI and SENSE scans were acquired. Additionally, fully sampled CS-PI and SENSE scans were retrospectively undersampled and reconstructed. Dynamic scans were performed using 5× to 7× accelerated scans in the presence of bowel motion. Retrospectively, undersampled scans were compared to fully sampled scans using structural similarity indices. All reconstructions were visually assessed for image quality and diagnostic quality by two radiologists. Results For static imaging, the performance of CS-PI was lower than that of fully sampled and SENSE scans: the diagnostic quality was assessed as adequate or good for 100% of fully sampled scans, 95% of SENSE, but only for 55% of CS-PI scans. For dynamic imaging, CS-PI image quality was scored similar to SENSE at high acceleration. Diagnostic quality of all scans was scored as adequate or good; 55% of CS-PI and 83% of SENSE scans were scored as good. Conclusion Compared to SENSE, current implementation of CS-PI performed less or equally good in terms of image quality and diagnostic quality. CS-PI did not show advantages over SENSE for three-dimensional bowel motility imaging.
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15
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de Jonge CS, Menys A, van Rijn KL, Bredenoord AJ, Nederveen AJ, Stoker J. Detecting the effects of a standardized meal challenge on small bowel motility with MRI in prepared and unprepared bowel. Neurogastroenterol Motil 2019; 31:e13506. [PMID: 30407694 PMCID: PMC7379305 DOI: 10.1111/nmo.13506] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 10/03/2018] [Accepted: 10/07/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE MRI is increasingly used to evaluate small bowel contractility. The objective of this study was to validate a clinically practical stimulation test (300-kcal meal) for small bowel motility. METHODS Thirty-one healthy subjects underwent dynamic MRI to capture global small bowel motility after ±10h fasting, of which 15 underwent bowel preparation consisting of 1 L 2.5% mannitol solution and 16 did not. Each subject underwent (1) a baseline motility scan (2) a food challenge (3) a post-challenge scan, and (4) second post-challenge scan (after ±20 minutes). This protocol was repeated within 2 weeks. Motility was quantified using a validated motility assessment technique. KEY RESULTS Motility in prepared subjects at baseline was significantly higher than motility in unprepared subjects (0.36 AU vs 0.18 AU, P < 0.001). In the prepared group, the food challenge produced an 8% increase in motility (P = 0.33) while in the unprepared subjects a significant increase of 30% was observed (P < 0.001). Responses to food remained insignificant (P = 0.21) and significant (P = 0.003), for the prepared and unprepared subjects, respectively, ±20 minutes post food challenge. These results were confirmed in the repeated scan session. CONCLUSION & INFERENCES A significant response to a 300-kcal meal was measured within 10 minutes in unprepared bowel, supporting the clinical use of this challenge to provoke and assess motility changes. A caloric challenge did not produce an observable increase in motility in mannitol prepared subjects.
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Affiliation(s)
- Catharina S. de Jonge
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Alex Menys
- Centre for Medical ImagingUniversity College London (UCL)LondonUK,Motilent, IDEALondonLondonUK
| | - Kyra L. van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Arjan J. Bredenoord
- Department of Gastroenterology and Hepatology, Amsterdam UMC, location Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location Academic Medical CenterUniversity of AmsterdamAmsterdamThe Netherlands
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16
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Maaser C, Sturm A, Vavricka SR, Kucharzik T, Fiorino G, Annese V, Calabrese E, Baumgart DC, Bettenworth D, Borralho Nunes P, Burisch J, Castiglione F, Eliakim R, Ellul P, González-Lama Y, Gordon H, Halligan S, Katsanos K, Kopylov U, Kotze PG, Krustinš E, Laghi A, Limdi JK, Rieder F, Rimola J, Taylor SA, Tolan D, van Rheenen P, Verstockt B, Stoker J. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 2019; 13:144-164. [PMID: 30137275 DOI: 10.1093/ecco-jcc/jjy113] [Citation(s) in RCA: 870] [Impact Index Per Article: 174.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Andreas Sturm
- Department of Gastroenterology, DRK Kliniken Berlin I Westend, Berlin, Germany
| | | | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Gionata Fiorino
- Department of Gastroenterology, Humanitas Clinical and Research Institute, Milan, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic & American Hospital, Dubai, UAE
| | - Emma Calabrese
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Paula Borralho Nunes
- Department of Anatomic Pathology, Hospital Cuf Descobertas; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Yago González-Lama
- Department of Gastroenterology, University Hospital Puerta De Hierro, Majadahonda [Madrid], Spain
| | - Hannah Gordon
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Paulo G Kotze
- Colorectal Surgery Unit, Catholic University of Paraná [PUCPR], Curitiba, Brazil
| | - Eduards Krustinš
- Department of of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andrea Laghi
- Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester; Manchester Academic Health Sciences Centre, University of Manchester, UK
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Damian Tolan
- Clinical Radiology, St James's University Hospital, Leeds, UK
| | - Patrick van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen, The Netherlands
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven and CHROMETA - Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center [AMC], University of Amsterdam, Amsterdam, The Netherlands
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17
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Hoad C, Clarke C, Marciani L, Graves MJ, Corsetti M. Will MRI of gastrointestinal function parallel the clinical success of cine cardiac MRI? Br J Radiol 2019; 92:20180433. [PMID: 30299989 PMCID: PMC6435057 DOI: 10.1259/bjr.20180433] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/21/2018] [Accepted: 10/03/2018] [Indexed: 12/11/2022] Open
Abstract
Cine cardiac MRI is generally accepted as the "gold-standard" for functional myocardial assessment. It only took a few years after the development of commercial MRI systems for functional cardiac imaging to be developed, with electrocardiogram (ECG)-gated cine imaging first reported in 1988. The function of the gastrointestinal (GI) tract is more complex to study compared to the heart. However, the idea of having a non-invasive tool to study the GI function that also allows the concurrent assessment of different aspects of this function has become more and more attractive in the gastroenterological field. This review summarises key literature of the last 5 years to describe the current status of MRI in respect to the evaluation of GI function, highlighting the gaps and challenges and the future prospects. As the clinical application of a new technique requires that its clinical utility is confirmed by demonstration of its ability to enable clinicians to make a diagnosis and/or predict the treatment response, this review also considers whether or not this has been achieved, and how MRI has been validated against techniques currently recognised as the gold standard in clinical practice.
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Affiliation(s)
| | - Christopher Clarke
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Martin John Graves
- Department of Radiology, Cambridge University Hospitals NHS Trust, Cambridge, UK
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18
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Menys A, Puylaert C, Tutein Nolthenius CE, Plumb AA, Makanyanga J, Tielbeek J, Pendse D, Brosens LA, Rodriguez-Justo M, Atkinson D, Bhatnagar G, Vos F, Stoker J, Taylor SA. Quantified Terminal Ileal Motility during MR Enterography as a Biomarker of Crohn Disease Activity: Prospective Multi-Institution Study. Radiology 2018; 289:428-435. [DOI: 10.1148/radiol.2018180100] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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19
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Park SH, Ye BD, Lee TY, Fletcher JG. Computed Tomography and Magnetic Resonance Small Bowel Enterography: Current Status and Future Trends Focusing on Crohn's Disease. Gastroenterol Clin North Am 2018; 47:475-499. [PMID: 30115433 DOI: 10.1016/j.gtc.2018.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are presently state-of-the-art radiologic tests used to examine the small bowel for various indications. This article focuses on CTE and MRE for the evaluation of Crohn disease. The article describes recent efforts to achieve more standardized interpretation of CTE and MRE, summarizes recent research studies investigating the role and impact of CTE and MRE more directly for several different clinical and research issues beyond general diagnostic accuracy, and provides an update on progress in imaging techniques. Also addressed are areas that need further exploration in the future.
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Affiliation(s)
- Seong Ho Park
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea.
| | - Byong Duk Ye
- Department of Gastroenterology, Inflammatory Bowel Disease Center, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Tae Young Lee
- Department of Radiology, Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, 200 First Street, Southwest, Rochester, MN 55905, USA
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20
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Gollifer RM, Menys A, Makanyanga J, Puylaert CAJ, Vos FM, Stoker J, Atkinson D, Taylor SA. Relationship between MRI quantified small bowel motility and abdominal symptoms in Crohn's disease patients-a validation study. Br J Radiol 2018; 91:20170914. [PMID: 29888980 PMCID: PMC6223161 DOI: 10.1259/bjr.20170914] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 03/28/2018] [Accepted: 06/04/2018] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Previous single-centre MRI data suggests an inverse correlation between normal small bowel motility variance and abdominal symptoms in Crohn's disease (CD) patients. The current work prospectively assesses this observation in a larger, two-centre study. METHODS MR enterography datasets were analysed from 82 patients (38 male, aged 16-68), who completed a contemporaneous Harvey-Bradshaw index (HBI) questionnaire. Dynamic "cine motility" breath-hold balanced steady-state free precession sequences were acquired through the whole small bowel (SB) volume. Regions of interest (ROIs) were manually applied to encompass all morphologically normal SB (i.e. excluding Crohn's affected bowel) and a validated registration technique used to produce motility maps. Mean and variance motility metrics were correlated with HBI and symptom components (well-being, pain and diarrhoea) using Spearman's correlation statistics. RESULTS Overall, motility variance was non-significantly negatively correlated with the total HBI score, (r = -0.17, p = 0.12), but for subjects with a HBI score over 10, the negative correlation was significant (r = -0.633, p = 0.027). Motility variance was negatively correlated with diarrhoea (r = -0.29, p < 0.01). No significant correlation was found between mean motility and HBI (r = -0.02, p = 0.84). CONCLUSION An inverse association between morphologically normal small bowel motility variance and patient symptoms has been prospectively confirmed in patients with HBI scores above 10. This association is particularly apparent for the symptom of diarrhoea. Advances in knowledge: This study builds on preliminary work by confirming in a large, well-controlled prospective multicentre study a relationship between normal bowel motility variance and patient reported symptoms which may have implications for drug development and clinical management.
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Affiliation(s)
- Ruaridh M Gollifer
- Centre for Medical Imaging, University College London (UCL), London, United Kingdom
| | - Alex Menys
- Centre for Medical Imaging, University College London (UCL), London, United Kingdom
| | - Jesica Makanyanga
- Centre for Medical Imaging, University College London (UCL), London, United Kingdom
| | - Carl AJ Puylaert
- Department of Radiology and Nuclear Medicine, Academic Medical Center (AMC), Amsterdam, Netherlands
| | | | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center (AMC), Amsterdam, Netherlands
| | - David Atkinson
- Centre for Medical Imaging, University College London (UCL), London, United Kingdom
| | - Stuart Andrew Taylor
- Centre for Medical Imaging, University College London (UCL), London, United Kingdom
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21
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de Jonge CS, Gollifer RM, Nederveen AJ, Atkinson D, Taylor SA, Stoker J, Menys A. Dynamic MRI for bowel motility imaging-how fast and how long? Br J Radiol 2018; 91:20170845. [PMID: 29474115 PMCID: PMC6209475 DOI: 10.1259/bjr.20170845] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective: Dynamic imaging of small intestinal motility is an increasingly common research method to examine bowel physiology in health and disease. However, limited data exist to guide imaging protocols with respect to quantitative analysis. The purpose of this study is to define the required temporal resolution and scan duration in dynamic MRI for small bowel motility assessment. Methods: Six healthy volunteers underwent motility imaging with MR enterography using breath-hold protocol. A coronal two-dimensional balanced fast field echo sequence was used to acquire dynamic data at a high temporal resolution of 10 frames per second (fps). Motility was quantified by generating a registration-derived motility index for local and global regions of bowel. To evaluate temporal resolution and scan duration, the data were undersampled and the scan length was varied to determine the impact on motility index. Results: The mean motility index stabilizes at a temporal resolution of 1 fps (median absolute percentage change 1.4% for global and 1.9% for local regions of interest). The mean motility index appears to stabilize for scan durations of 15 s or more in breath-hold (median absolute % change 2.8% for global and 1.7% for local regions of interest). Conclusion: A temporal resolution of at least 1 fps and a scan duration of at least 15 s is necessary in breath-hold scans for consistent motility observations. The majority of small bowel motility studies to date are in line with these requirements. Advances in knowledge: This study suggests the minimum temporal resolution and scan duration required in breath-hold scans to obtain robust measurements of small bowel motility from MRI.
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Affiliation(s)
- Catharina S de Jonge
- 1 Department of Radiology and Nuclear Medicine, Academic Medical Center , Amsterdam , Netherlands
| | | | - Aart J Nederveen
- 1 Department of Radiology and Nuclear Medicine, Academic Medical Center , Amsterdam , Netherlands
| | - David Atkinson
- 2 Centre for Medical Imaging, University College London , London , UK
| | - Stuart A Taylor
- 2 Centre for Medical Imaging, University College London , London , UK
| | - Jaap Stoker
- 1 Department of Radiology and Nuclear Medicine, Academic Medical Center , Amsterdam , Netherlands
| | - Alex Menys
- 2 Centre for Medical Imaging, University College London , London , UK
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22
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de Jonge CS, Smout AJPM, Nederveen AJ, Stoker J. Evaluation of gastrointestinal motility with MRI: Advances, challenges and opportunities. Neurogastroenterol Motil 2018; 30. [PMID: 29265641 DOI: 10.1111/nmo.13257] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 10/30/2017] [Indexed: 12/19/2022]
Abstract
Dynamic magnetic resonance imaging (MRI) of gastrointestinal motility has developed rapidly over the past few years. The non-invasive and non-ionizing character of MRI is an important advantage together with the fact that it is fast and can visualize the entire gastrointestinal tract. Advances in imaging and quantification techniques have facilitated assessment of gastric, small intestinal, and colonic motility in a clinical setting. Automated quantitative motility assessment using dynamic MRI meets the need for non-invasive techniques. Recently, studies have begun to examine this technique in patients, including those with IBD, pseudo-obstruction and functional bowel disorders. Remaining challenges for clinical implementation are processing the large amount of data, standardization and validation of the numerous MRI metrics and subsequently assessment of the potential role of dynamic MRI. This review examines the methods, advances, and remaining challenges of evaluation of gastrointestinal motility with MRI. It accompanies an article by Khalaf et al. in this journal that describes a new protocol for assessment of pan-intestinal motility in fasted and fed state in a single MRI session.
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Affiliation(s)
- C S de Jonge
- Department of Radiology and Nuclear Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - A J P M Smout
- Department of Gastroenterology & Hepatology, Academic Medical Center (AMC), Amsterdam, the Netherlands
| | - A J Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, the Netherlands
| | - J Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center (AMC), University of Amsterdam, Amsterdam, the Netherlands
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23
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Abstract
PURPOSE OF REVIEW Small bowel motility disorders constitute a relatively small but important segment of clinical gastroenterology. Presenting features encompass a broad range of symptom manifestations and severity: from chronic functional-type complaints to life-threatening nutritional impairment. Diagnostic assessment of patients with suspected intestinal motility disorders is often hampered by the complexity of measuring intestinal contractile activity in humans. In this review, we describe and critically comment the main current and forthcoming methodologies. RECENT FINDINGS Beyond conventional small bowel manometry, radiological methods, and intestinal transit tests that have been available for several decades, now we focus on novel methodologies such as high-resolution manometry, magnetic resonance methodology, and endoluminal capsule image analysis. Gradual introduction of new approaches to diagnostic investigation of patients with suspected intestinal motility disorders should facilitate a less invasive and more accurate characterization of disturbed motor function. Enhanced understanding of the pathophysiological basis of clinical conditions should allow better application of therapeutic approaches that are also highlighted in this review.
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Affiliation(s)
- Carolina Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Department of Medicine, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain.
| | - Juan R Malagelada
- Digestive System Research Unit, University Hospital Vall d'Hebron; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd); Department of Medicine, Universitat Autònoma de Barcelona, 08035, Barcelona, Spain
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24
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Hahnemann M, Dechene A, Kathemann S, Sirin S, Gerken G, Lauenstein T, Kinner S. Diagnostic value of diffusion-weighted imaging (DWI) for the assessment of the small bowel in patients with inflammatory bowel disease. Clin Radiol 2017; 72:95.e1-95.e8. [DOI: 10.1016/j.crad.2016.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 07/28/2016] [Accepted: 08/18/2016] [Indexed: 12/22/2022]
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25
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Bhatnagar G, Von Stempel C, Halligan S, Taylor SA. Utility of MR enterography and ultrasound for the investigation of small bowel Crohn's disease. J Magn Reson Imaging 2016; 45:1573-1588. [PMID: 27943484 DOI: 10.1002/jmri.25569] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/11/2016] [Indexed: 12/18/2022] Open
Abstract
Cross sectional Imaging plays an increasingly important role the diagnosis and management of Crohn's disease. Particular emphasis is placed on MRI and Ultrasound as they do not impart ionising radiation. Both modalities have reported high sensitivity for disease detection, activity assessment and evaluation of extra-luminal complications, and have positive effects on clinical decision making. International Guidelines now recommend MRI and Ultrasound in the routine management of Crohn's disease patients. This article reviews the current evidence base supporting both modalities with an emphasis on the key clinical questions. We describe current protocols, basic imaging findings and highlight areas in need of further research. LEVEL OF EVIDENCE 5 Technical Efficacy: Stage 4 J. MAGN. RESON. IMAGING 2017;45:1573-1588.
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Affiliation(s)
- Gauraang Bhatnagar
- Frimley Park Hospital NHS Foundation Trust, London, UK.,Centre for Medical Imaging, University College London, London, UK
| | | | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
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26
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Abstract
Accurately measuring the complex motor behaviors of the gastrointestinal tract has tremendous value for the understanding, diagnosis and treatment of digestive diseases. This review synthesizes the literature regarding current tests that are used in both humans and animals. There remains further opportunity to enhance such tests, especially when such tests are able to provide value in both the preclinical and the clinical settings.
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Key Words
- acute pancreatitis
- biliary pancreatitis
- necroptosis
- apoptosis
- pancreatic cell death
- ac, ascending colon
- cf6, filling the colon at 6 hours
- ct, computed tomography
- gebt, gastric emptying breath test
- hdam, high-definition anorectal pressure manometry/topography
- hram, high-resolution anorectal manometry
- ht, hydroxytryptophan
- iqr, interquartile range
- mmc, migrating motor complex
- mri, magnetic resonance imaging
- 99mtc, technetium-99m
- spect, single-photon emission computed tomography
- 13c, carbon-13
- 3-d, 3-dimensional
- wmc, wireless motility capsule
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27
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Hoad CL, Menys A, Garsed K, Marciani L, Hamy V, Murray K, Costigan C, Atkinson D, Major G, Spiller RC, Taylor SA, Gowland PA. Colon wall motility: comparison of novel quantitative semi-automatic measurements using cine MRI. Neurogastroenterol Motil 2016; 28:327-35. [PMID: 26612075 DOI: 10.1111/nmo.12727] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 10/15/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Recently, cine magnetic resonance imaging (MRI) has shown promise for visualizing movement of the colonic wall, although assessment of data has been subjective and observer dependent. This study aimed to develop an objective and semi-automatic imaging metric of ascending colonic wall movement, using image registration techniques. METHODS Cine balanced turbo field echo MRI images of ascending colonic motility were acquired over 2 min from 23 healthy volunteers (HVs) at baseline and following two different macrogol stimulus drinks (11 HVs drank 1 L and 12 HVs drank 2 L). Motility metrics derived from large scale geometric and small scale pixel movement parameters following image registration were developed using the post ingestion data and compared to observer grading of wall motion. Inter and intra-observer variability in the highest correlating metric was assessed using Bland-Altman analysis calculated from two separate observations on a subset of data. KEY RESULTS All the metrics tested showed significant correlation with the observer rating scores. Line analysis (LA) produced the highest correlation coefficient of 0.74 (95% CI: 0.55-0.86), p < 0.001 (Spearman Rho). Bland-Altman analysis of the inter- and intra-observer variability for the LA metric, showed almost zero bias and small limits of agreement between observations (-0.039 to 0.052 intra-observer and -0.051 to 0.054 inter-observer, range of measurement 0-0.353). CONCLUSIONS & INFERENCES The LA index of colonic motility derived from cine MRI registered data provides a quick, accurate and non-invasive method to detect wall motion within the ascending colon following a colonic stimulus in the form of a macrogol drink.
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Affiliation(s)
- C L Hoad
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK.,NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, Nottingham University Hospitals Trust and the University of Nottingham, Nottingham, UK
| | - A Menys
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - K Garsed
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, Nottingham University Hospitals Trust and the University of Nottingham, Nottingham, UK
| | - L Marciani
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, Nottingham University Hospitals Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - V Hamy
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - K Murray
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - C Costigan
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
| | - D Atkinson
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - G Major
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, Nottingham University Hospitals Trust and the University of Nottingham, Nottingham, UK
| | - R C Spiller
- NIHR Biomedical Research Unit in Gastrointestinal and Liver Diseases, Nottingham University Hospitals Trust and the University of Nottingham, Nottingham, UK.,Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - S A Taylor
- Centre for Medical Imaging, Division of Medicine, University College London, London, UK
| | - P A Gowland
- Sir Peter Mansfield Imaging Centre, School of Physics and Astronomy, University of Nottingham, Nottingham, UK
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28
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Åkerman A, Månsson S, Fork FT, Leander P, Ekberg O, Taylor S, Menys A, Ohlsson B. Computational postprocessing quantification of small bowel motility using magnetic resonance images in clinical practice: An initial experience. J Magn Reson Imaging 2016; 44:277-87. [PMID: 26801196 DOI: 10.1002/jmri.25166] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 01/10/2016] [Indexed: 02/06/2023] Open
Abstract
PURPOSE To study the feasibility and to gauge the potential clinical impact of quantifying small bowel motility using magnetic resonance imaging (MRI) in a larger population with a spectra of gastrointestinal conditions with impaired small bowel motility. MATERIALS AND METHODS Data were gathered retrospectively from a cohort of 127 patients undergoing MR enterography (1.5 Tesla) in 2011. Cine motility sequences were processed with validated motility analysis software and a parametric motility map was generated. Regions of interests were drawn in the jejunum, ileum, and terminal ileum, and Jacobian standard deviation mean motility index' score (MIS) was calculated. Patients were divided into Crohn's disease (CD), ulcerative colitis, irritable bowel syndrome, and healthy subjects. RESULTS In CD, terminal ileum motility was lower in comparison to healthy subjects (mean difference: -0.1052 arbitrary units, 95% confidence interval: -0.1981--0.0122, P = 0.018). Subgrouping of CD showed that the difference was recognized in patients with disease limited to the small bowel (mean difference: -0.1440 arbitrary units, 95% confidence interval: -0.2491--0.0389, P = 0.002). Visible dysmotility of terminal ileum on MRI reflected a reduced MIS compared with normal motility (0.22 ± 0.09 and 0.33 ± 0.15 arbitrary units, respectively, P = 0.043). Motility correlated negatively between ileum and age (P = 0.021), and between terminal ileum and C-reactive protein in ulcerative colitis (P = 0.031). CONCLUSION Motility quantitation revealed a significant difference in motility of terminal ileum in patients with small bowel CD compared with healthy subjects, concording with visible dysmotility and inflammatory changes. J. Magn. Reson. Imaging 2016;44:277-287.
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Affiliation(s)
- André Åkerman
- Department of Clinical Sciences, Division of Internal Medicine, Skåne University Hospital, Malmö, Lund University, Sweden
| | - Sven Månsson
- Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Frans-Thomas Fork
- Department of Imaging and Function, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Peter Leander
- Department of Imaging and Function, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Olle Ekberg
- Department of Imaging and Function, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Stuart Taylor
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Alex Menys
- Centre for Medical Imaging, University College London, London, United Kingdom
| | - Bodil Ohlsson
- Department of Clinical Sciences, Division of Internal Medicine, Skåne University Hospital, Malmö, Lund University, Sweden
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29
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Khalaf A, Hoad CL, Spiller RC, Gowland PA, Moran GW, Marciani L. Magnetic resonance imaging biomarkers of gastrointestinal motor function and fluid distribution. World J Gastrointest Pathophysiol 2015; 6:140-149. [PMID: 26600972 PMCID: PMC4644878 DOI: 10.4291/wjgp.v6.i4.140] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/28/2015] [Accepted: 10/27/2015] [Indexed: 02/07/2023] Open
Abstract
Magnetic resonance imaging (MRI) is a well established technique that has revolutionized diagnostic radiology. Until recently, the impact that MRI has had in the assessment of gastrointestinal motor function and bowel fluid distribution in health and in disease has been more limited, despite the novel insights that MRI can provide along the entire gastrointestinal tract. MRI biomarkers include intestinal motility indices, small bowel water content and whole gut transit time. The present review discusses new developments and applications of MRI in the upper gastrointestinal tract, the small bowel and the colon reported in the literature in the last 5 years.
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