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van Rijn KL, Stoker J, Menys A, de Jonge CS. Impact of bowel dilation on small bowel motility measurements with cine-MRI: assessment of two quantification techniques. BJR Open 2022; 4:20210049. [PMID: 36105419 PMCID: PMC9459865 DOI: 10.1259/bjro.20210049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/04/2022] [Accepted: 02/07/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives To evaluate the effect of bowel dilation on cine-MRI small bowel motility measurements, by comparing a conventional motility score (including bowel wall and lumen) with a bowel wall-specific motility score in healthy and diseased populations. Methods Four populations were included: 10 Crohn's patients with a stricture and prestricture dilation for segmental motility analysis, and 14 mannitol-prepared healthy subjects, 15 fasted healthy subjects and eight chronic intestinal pseudo-obstruction (CIPO) patients (characterized by dilated bowel loops) for global small bowel motility analysis. All subjects underwent a cine-MRI scan from which two motility scores were calculated: a conventional score (including bowel wall and lumen) and a bowel wall-specific score. The difference between the two scores was calculated per population and compared between groups with a one-way ANOVA and Tukey-Kramer analysis. Results In Crohn's patients, the median (IQR) change between the conventional and wall-specific motility score was 0% (-2 to +4%) within the stricture and 0% (-1 to +7%) in the prestricture dilation. For the global small bowel, this was -1% (-5 to 0%) in mannitol-prepared healthy subjects, -2% (-6 to +2%) in fasted healthy subjects and +14% (+6 to+20%) in CIPO patients. The difference between the two motility scores in CIPO patients differed significantly from the four other groups (p = 0.002 to p < 0.001). Conclusions The conventional small bowel motility score seems robust in Crohn's disease patients and healthy subjects. In patients with globally and grossly dilated bowel loops, a bowel-wall specific motility score may give a better representation of small bowel motility. Advances in knowledge These findings support researchers and clinicians with making informed choices for using cine-MRI motility analysis in different populations.
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Affiliation(s)
- Kyra L van Rijn
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Catharina S de Jonge
- Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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2
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Wells CI, Milne TGE, Seo SHB, Chapman SJ, Vather R, Bissett IP, O'Grady G. Post-operative ileus: definitions, mechanisms and controversies. ANZ J Surg 2021; 92:62-68. [PMID: 34676664 DOI: 10.1111/ans.17297] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 12/13/2022]
Abstract
Post-operative ileus (POI) is a syndrome of impaired gastrointestinal transit which occurs following abdominal surgery. There are few effective targeted therapies for ileus, and research has been limited by inconsistent definitions and an incomplete understanding of the underlying pathophysiology. Despite considerable effort, there remains no widely-adopted definition of ileus, and recent work has identified variation in outcome reporting is a major source of heterogeneity in clinical trials. Outcomes should be clearly-defined, clinically-relevant, and reflective of the underlying biology, impacts on hospital resources and quality of life. Further collaborative efforts will be needed to develop consensus definitions and a core outcome set for postoperative gastrointestinal recovery. Investigation into the pathophysiology of POI has been hindered by use of low-resolution techniques and difficulties linking cellular mechanisms to dysmotility patterns and clinical symptoms. Recent evidence has suggested the common assumption of post-operative GI paralysis is incorrect, and that the distal colon becomes hyperactive following surgery. The post-operative inflammatory response is important in the pathophysiology of ileus, but the time course of this in humans remains unclear, with the majority of evidence coming from animal models. Future work should investigate dysmotility patterns underlying ileus, and identify biomarkers which may be used to diagnose, monitor and stratify patients with ileus.
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Affiliation(s)
- Cameron I Wells
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Tony G E Milne
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Counties Manukau District Health Board, Auckland, New Zealand
| | - Sean Ho Beom Seo
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | | | - Ryash Vather
- Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ian P Bissett
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland District Health Board, Auckland, New Zealand
| | - Greg O'Grady
- Department of Surgery, The University of Auckland, Auckland, New Zealand.,Department of Surgery, Auckland District Health Board, Auckland, New Zealand.,Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
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Williams SL, Tkach JA, Rattan MS, South AP, Wessel J, Kingma PS. Feeding Tolerance, Intestinal Motility, and Superior Mesenteric Artery Blood Flow in Infants with Gastroschisis. Neonatology 2020; 117:95-101. [PMID: 31851996 DOI: 10.1159/000504226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 10/17/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine the relationship of superior mesenteric artery (SMA) blood flow and intestinal motility with feeding tolerance in infants with gastroschisis. STUDY DESIGN This was a prospective observational cohort study of 23 infants with gastroschisis. Magnetic resonance images were obtained at abdominal wall closure, initiation of feeds, and full feeds. Motility and SMA flow data were correlated with feeding tolerance. RESULT All infants had abnormal motility, and most continued with abnormal motility despite achieving full feeds. Increased SMA flow at the time of abdominal wall closure was found to be significantly related to the earlier achievement of full feeds (ρ = -0.45, p = 0.05) and trended towards earlier initiation of feeds (ρ = -0.36, p = 0.13), shorter parenteral nutrition days (ρ = -0.42, p = 0.07), and earlier discharge (ρ = -0.41, p = 0.08). CONCLUSION Increased SMA blood flow at the time of abdominal wall closure is positively correlated with feeding tolerance, suggesting the importance of initial intestinal perfusion in the pathophysiology for feeding intolerance and intestinal dysmotility in gastroschisis.
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Affiliation(s)
- Sadie L Williams
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jean A Tkach
- Imaging Research Center and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Mantosh S Rattan
- Imaging Research Center and Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Andrew P South
- Division of Neonatology, Children's Hospital Medical Center of Akron, Akron, Ohio, USA
| | - Jacqueline Wessel
- Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul S Kingma
- The Perinatal Institute, Section of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA, .,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA, .,Cincinnati Fetal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA,
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5
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Wells CI, O'Grady G, Bissett IP. Colonic Electromechanical Abnormalities Underlying Post-operative Ileus: A Systematic and Critical Review. J Neurogastroenterol Motil 2019; 25:36-47. [PMID: 30504526 PMCID: PMC6326204 DOI: 10.5056/jnm18030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/20/2018] [Accepted: 07/21/2018] [Indexed: 12/25/2022] Open
Abstract
Post-operative ileus (POI) is an inevitable consequence of major abdominal surgery, and may be prolonged in up to 30% of patients. Ileus is commonly presumed to result from paralysis of the GI tract, though there is little direct evidence to support this view. The aim of this review is to systematically search and critically review the literature investigating post-operative colonic electrical and mechanical activity. MEDLINE and Embase databases were systematically searched for articles investigating post-operative colonic motor or electrical activity in human patients. Nineteen original articles investigating post-operative colonic motor or electrical activity were identified. Most studies have used low-resolution techniques, with intermittent recordings of colonic motility. Numerous studies have shown that colonic electrical and motor activity does not cease routinely following surgery, but is of abnormal character for 3–6 days following laparotomy. One recent high-resolution manometry study identified hyperactive cyclic motor patterns occurring in the distal colon on the first post-operative day. Low-resolution studies have shown colonic slow waves are not inhibited by surgery, and are present even in the immediate post-operative period. Recovery of normal motility appears to occur in a proximal to distal direction and is temporally correlated with the clinical return of bowel function. No studies have investigated motility specifically in prolonged POI. Future studies should use high-resolution techniques to accurately characterise abnormalities in electrical and mechanical function underlying POI, and correlate these changes with clinical recovery of bowel function.
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Affiliation(s)
- Cameron I Wells
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Gregory O'Grady
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand.,Department of Surgery, Auckland District Health Board, Auckland, New Zealand.,Auckland Bioengineering Institute, The University of Auckland, New Zealand
| | - Ian P Bissett
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand.,Department of Surgery, Auckland District Health Board, Auckland, New Zealand
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Pei M, Wu X, Guo Y, Fujita H. Small bowel motility assessment based on fully convolutional networks and long short-term memory. Knowl Based Syst 2017. [DOI: 10.1016/j.knosys.2017.01.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Guglielmo FF, Mitchell DG, O'Kane PL, Deshmukh SP, Roth CG, Burach I, Burns A, Dulka S, Parker L. Identifying decreased peristalsis of abnormal small bowel segments in Crohn's disease using cine MR enterography: the frozen bowel sign. ACTA ACUST UNITED AC 2016; 40:1150-6. [PMID: 25326259 DOI: 10.1007/s00261-014-0258-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The purpose of this study was to evaluate whether affected bowel in Crohn's disease patients can be identified by observing decreased peristalsis (frozen bowel sign) using cine balanced steady-state free precession (cine BSSFP) images. MATERIALS AND METHODS 5 radiologists independently reviewed cine BSSFP sequences from randomized MR Enterography (MRE) exams for 30 normal and 30 Crohn's disease patients, graded overall small bowel peristalsis from slowest to fastest, and graded peristalsis for the most abnormal small bowel segment. Sensitivity and specificity of the frozen bowel sign for diagnosing Crohn's disease were calculated. T tests of the peristalsis difference between abnormal segments and overall small bowel were conducted. RESULTS For 5 readers, the sensitivity and specificity of cine BSSFP of the frozen bowel sign for diagnosing Crohn's disease ranged from 70% to 100% and 87% to 100%, respectively. There were significant differences in peristalsis between abnormal small bowel segments and the overall small bowel for Crohn's patients, but not in the overall small bowel between normal-MRE patients and Crohn's disease patients. CONCLUSION Abnormal Crohn's small bowel segments have significantly decreased peristalsis compared to normal small bowel, which can be identified using cine BSSFP sequences as the frozen bowel sign.
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Affiliation(s)
- Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA,
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Whitehead K, Cortes Y, Eirmann L. Gastrointestinal dysmotility disorders in critically ill dogs and cats. J Vet Emerg Crit Care (San Antonio) 2016; 26:234-53. [PMID: 26822390 DOI: 10.1111/vec.12449] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 07/21/2015] [Accepted: 08/30/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the human and veterinary literature regarding gastrointestinal (GI) dysmotility disorders in respect to pathogenesis, patient risk factors, and treatment options in critically ill dogs and cats. ETIOLOGY GI dysmotility is a common sequela of critical illness in people and small animals. The most common GI motility disorders in critically ill people and small animals include esophageal dysmotility, delayed gastric emptying, functional intestinal obstruction (ie, ileus), and colonic motility abnormalities. Medical conditions associated with the highest risk of GI dysmotility include mechanical ventilation, sepsis, shock, trauma, systemic inflammatory response syndrome, and multiple organ failure. The incidence and pathophysiology of GI dysmotility in critically ill small animals is incompletely understood. DIAGNOSIS A presumptive diagnosis of GI dysmotility is often made in high-risk patient populations following detection of persistent regurgitation, vomiting, lack of tolerance of enteral nutrition, abdominal pain, and constipation. Definitive diagnosis is established via radioscintigraphy; however, this diagnostic tool is not readily available and is difficult to perform on small animals. Other diagnostic modalities that have been evaluated include abdominal ultrasonography, radiographic contrast, and tracer studies. THERAPY Therapy is centered at optimizing GI perfusion, enhancement of GI motility, and early enteral nutrition. Pharmacological interventions are instituted to promote gastric emptying and effective intestinal motility and prevention of complications. Promotility agents, including ranitidine/nizatidine, metoclopramide, erythromycin, and cisapride are the mainstays of therapy in small animals. PROGNOSIS The development of complications related to GI dysmotility (eg, gastroesophageal reflux and aspiration) have been associated with increased mortality risk. Institution of prophylaxic therapy is recommended in high-risk patients, however, no consensus exists regarding optimal timing of initiating prophylaxic measures, preference of treatment, or duration of therapy. The prognosis for affected small animal patients remains unknown.
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Affiliation(s)
- KimMi Whitehead
- Emergency and Critical Care Department, Oradell Animal Hospital, Paramus, NJ, 07452
| | - Yonaira Cortes
- Emergency and Critical Care Department, Oradell Animal Hospital, Paramus, NJ, 07452
| | - Laura Eirmann
- the Nutrition Department (Eirmann), Oradell Animal Hospital, Paramus, NJ, 07452
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9
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Bickelhaupt S, Cattin R, Froehlich JM, Raible S, Bouquet H, Bill U, Patak MA. Automatic detection of small bowel contraction frequencies in motility plots using lomb-scargle periodogram and sinus-fitting method--initial experience. Magn Reson Med 2016; 71:628-34. [PMID: 23467927 DOI: 10.1002/mrm.24708] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Contraction frequencies are an important parameter for the analysis of bowel motility in MRI. The contraction curve can be rather noisy and the frequency-evaluation might be difficult. The aim was to evaluate manual calculations of small bowel contraction frequency in comparison with automatic calculations using two mathematically established methods. METHODS The institutional-review-board approved study consisted of 48 segmental small-bowel motility-plots out of a previous study with 25 patients (15 men/10 women; mean 39 years, standard deviation ± 14.67) undergoing MRI (1.5 T, GE-Medical Systems; two-dimensional-Fiesta, pulse repetition time 2.91, echo time 1.25, flip-angle 45°, matrix 256 × 256, slice thickness 10 mm) were evaluated. Calculations of contraction frequency was performed either manually or using Lomb-Scargle-periodograms and Sinus-Fitting method. The results were compared using intraclass correlation coefficient, Friedman's-test and Wilcoxon-matched-paired-signed-rank-test (P < 0.05 considered statistically significant). RESULTS Mean contraction frequency was 5.69 (standard deviation ± 1.99) for manual calculations showing moderate interreader reliability (intraclass correlation coefficient 0.72; 95% confidence-interval: 0.59;0.82). No significant difference (P = 0.776) was found to Lomb-Scargle-periodograms (5.34 contractions-per-minute [cpm], standard deviation ± 2.47; P = 0.174) and to the sinus-fitting-method (5.47 cpm; standard deviation ± 2.57; P = 0.0779). For the latter calculations failed in 3/48 plots, while manual and Lomb-Scargle-periodograms could be performed successfully in all 48/48 plots. CONCLUSION Herein, we could show that Lomb-Scargle-periodograms and Sinus-Fitting are fast and reliable methods to automatically measure small-bowel contraction frequencies even in noisy small bowel motility plots.
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Affiliation(s)
- Sebastian Bickelhaupt
- Department of Radiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
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10
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Wnorowski AM, Guglielmo FF, Mitchell DG. How to perform and interpret cine MR enterography. J Magn Reson Imaging 2015; 42:1180-9. [DOI: 10.1002/jmri.24981] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 06/02/2015] [Indexed: 12/15/2022] Open
Affiliation(s)
- Amelia M. Wnorowski
- Thomas Jefferson University Hospital; Department of Radiology; Philadelphia Pennsylvania USA
| | - Flavius F. Guglielmo
- Thomas Jefferson University Hospital; Department of Radiology; Philadelphia Pennsylvania USA
| | - Donald G. Mitchell
- Thomas Jefferson University Hospital; Department of Radiology; Philadelphia Pennsylvania USA
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11
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Sinko K, Czerny C, Jagsch R, Baumann A, Kulinna-Cosentini C. Dynamic 1.5-T vs 3-T true fast imaging with steady-state precession (trueFISP)-MRI sequences for assessment of velopharyngeal function. Dentomaxillofac Radiol 2015; 44:20150028. [PMID: 26090932 DOI: 10.1259/dmfr.20150028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To compare the image quality of MRI scans produced with 1.5- and 3.0-T devices during functional test condition. METHODS 65 MRI scans obtained with 1.5- (n = 43) or 3.0-T (n = 22) true fast imaging with steady-state precession (trueFISP) sequences from patients with a history of a cleft palate were evaluated. Two experts assessed the MRI scans, independently of each other, and blinded to the MRI technique used. Subjective ratings were entered on a five-point Likert scale. The median planes of three anatomical structures (velum, tongue and pharyngeal wall) were assessed in three functional states (at rest, during phonation of sustained "e" and during articulation of "kkk"). In addition, MRI scans taken during velopharyngeal closure were evaluated. RESULTS Under blinded conditions, both observers (radiologist and orthodontist) independently rated the quality of 1.5-T scans higher than that of 3.0 T. Statistical analysis of pooled data showed that the differences were highly significant (p < 0.009) in 4 out of 10 test conditions. The greatest differences in favour of 1.5 T were observed for MRI scans of the velum. CONCLUSIONS 1.5 T used with trueFISP may be preferable over 3.0-T trueFISP for the evaluation of the velopharyngeal structures in the clinical routine.
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Affiliation(s)
- K Sinko
- 1 Department of Cranio-Maxillofacial and Oral Surgery, Medical University Vienna, Vienna, Austria
| | - C Czerny
- 2 Department of Biomedical Imaging und Image-guided Therapy, Medical University Vienna, Vienna, Austria
| | - R Jagsch
- 3 Institute of Clinical Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - A Baumann
- 1 Department of Cranio-Maxillofacial and Oral Surgery, Medical University Vienna, Vienna, Austria
| | - C Kulinna-Cosentini
- 2 Department of Biomedical Imaging und Image-guided Therapy, Medical University Vienna, Vienna, Austria
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12
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Bickelhaupt S, Wurnig MC, Lesurtel M, Patak MA, Boss A. Quantitative in vivo analysis of small bowel motility using MRI examinations in mice--proof of concept study. Lab Anim 2015; 49:57-64. [PMID: 25266965 DOI: 10.1177/0023677214553321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Small bowel motility analyses using magnetic resonance imaging (MRI) could reduce current invasive techniques in animal studies and comply with the 'three Rs' rule for human animal experimentation. Thus we investigated the feasibility of in vivo small bowel motility analyses in mice using dynamic MRI acquisitions. All experimental procedures were approved by the institutional animal care committee. Six C57BL/6 mice underwent MRI without additional preparation after isoflurane anaesthetization in the prone position on a 4.7 T small animal imager equipped with a linear polarized hydrogen birdcage whole-body mouse coil. Motility was assessed using a true fast imaging in a steady precession sequence in the coronal orientation (acquisition time per slice 512 ms, in-plane resolution 234 × 234 µm, matrix size 128 × 128, slice thickness 1 mm) over 30 s corresponding to 60 acquisitions. Motility was manually assessed measuring the small bowel diameter change over time. The resulting motility curves were analysed for the following parameters: contraction frequency per minute (cpm), maximal contraction amplitude (maximum to minimum [mm]), luminal diameter (mm) and luminal occlusion rate. Small bowel motility quantification was found to be possible in all animals with a mean small bowel contraction frequency of 10.67 cpm (SD ± 3.84), a mean amplitude of the contractions of 1.33 mm (SD ± 0.43) and a mean luminal diameter of 1.37 mm (SD ± 0.42). The mean luminal occlusion rate was 1.044 (SD ± 0.45%/100). The mean duration needed for a single motility assessment was 185 s (SD ± 54.02). Thus our study demonstrated the feasibility of an easy and time-sparing functional assessment for in vivo small bowel motility analyses in mice. This could improve the development of small animal models of intestinal diseases and provide a method similar to clinical MR examinations that is in concordance with the 'three Rs' for humane animal experimentation.
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Affiliation(s)
- S Bickelhaupt
- Department of Radiology, University Hospital Zürich, Zürich, Switzerland Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - M C Wurnig
- Department of Radiology, University Hospital Zürich, Zürich, Switzerland
| | - M Lesurtel
- Department of Surgery, University Hospital Zürich, Zürich, Switzerland
| | - M A Patak
- Department of Radiology, University Hospital Zürich, Zürich, Switzerland Institute of Radiology, Hirslanden Clinics Zürich, Zürich, Switzerland
| | - A Boss
- Department of Radiology, University Hospital Zürich, Zürich, Switzerland
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13
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Guglielmo FF, Mitchell DG, O’Kane PL, Deshmukh SP, Roth CG, Burach I, Burns A, Dulka S, Parker L. Erratum to: Identifying decreased peristalsis of abnormal small bowel segments in Crohn’s disease using cine MR enterography: the frozen bowel sign. ACTA ACUST UNITED AC 2014; 40:1138-49. [PMID: 25445157 DOI: 10.1007/s00261-014-0293-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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14
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Bickelhaupt S, Froehlich JM, Patak MA. Automated small bowel motility measurements in MRI using 2D coronal slices - does the intrasegmental location matter? A pilot study. Clin Imaging 2014; 39:89-93. [PMID: 25457530 DOI: 10.1016/j.clinimag.2014.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 12/30/2022]
Abstract
INTRODUCTION To evaluate if small bowel motility analyses are influenced by the positioning of the 2D-cross-section measurement point within the lumen. MATERIALS AND METHODS Forty-four small-bowel motility measurements were included in this institutional review board-approved, prospective study. Motility sequences (Dixon-dynFFE; Temporal-resolution 1s, breath-hold) of the ileocecal region were acquired using magnetic resonance imaging (3.0-Tesla; Ingenia-Philips). Motility was analyzed in three different compartments of the small bowel lumen (ventral, central, dorsal). Curve characteristics were statistically compared. RESULTS Mean luminal diameter, contraction amplitudes (P>.05) and the extent of luminal occlusion during contraction (P=.11) did not differ significantly between the compartments (ventral/central/dorsal) of the bowel lumen. CONCLUSION Quantitative motility parameters are not substantially influenced by the choice of cross sections on coronal planes as long as the segment is visible throughout the measurement.
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Affiliation(s)
- Sebastian Bickelhaupt
- Department of Radiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Johannes M Froehlich
- Department of Radiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland
| | - Michael A Patak
- Department of Radiology, University Hospital Zürich, Rämistrasse 100, 8091 Zürich, Switzerland; Department of Radiology, Hirslanden Clinics Zürich, Witellikerstrasse 40, 8032 Zürich, Switzerland.
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Bickelhaupt S, Froehlich JM, Wentz KU, von Weymarn C, Patak MA. Small-bowel dislocation during long-term MRI observation - insights in intestinal physiology. Clin Physiol Funct Imaging 2014; 35:41-48. [PMID: 24418110 DOI: 10.1111/cpf.12124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 12/11/2013] [Indexed: 12/15/2022]
Abstract
Magnetic resonance imaging (MRI) of the abdomen is a widely established imaging modality in the diagnostic workup of patients suffering from abdominal disorders. Small-bowel motility analyses using MRI have recently been introduced to provide functional information about the intestine not provided by morphological analyses. This is of clinical importance as motility disorders correlate with inflammation. Yet motility analyses mainly rely on a series of acquisitions in coronal orientation. Temporal displacement of small-bowel loops out of the coronal slice could falsify qualitative and quantitative motility analyses. Thus, our study quantified three-dimensional (3D) dislocation of small-bowel loops during abdominal MRI examinations with the patient lying in prone position to investigate its influence on motility analyses. Our study revealed segmental small-bowel displacement during MRI examinations in prone position to predominantly occur in craniocaudal orientation and in a smaller extent in lateral and ventrodorsal orientation. However, the displacement amplitudes are rather small and might not significantly influence small-bowel motility analyses in 2D coronal plane in general.
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Affiliation(s)
| | | | - Klaus-Ulrich Wentz
- Department of Radiology, Cantonal Hospital, STGAG, Muensterlingen, Switzerland
| | | | - Michael A Patak
- Department of Radiology, University Hospital Zürich, Zürich, Switzerland
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16
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Bickelhaupt S, Froehlich JM, Cattin R, Raible S, Bouquet H, Bill U, Patak MA. Software-assisted quantitative analysis of small bowel motility compared to manual measurements. Clin Radiol 2014; 69:363-71. [PMID: 24424326 DOI: 10.1016/j.crad.2013.11.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 11/04/2013] [Accepted: 11/05/2013] [Indexed: 12/30/2022]
Abstract
AIM To validate a newly developed software prototype that automatically analyses small bowel motility by comparing it directly with manual measurement. MATERIAL AND METHODS Forty-five patients with clinical indication for small bowel magnetic resonance imaging (MRI) were retrospectively included in this institutional review board-approved study. MRI was performed using a 1.5 T system following a standard MR-enterography protocol. Small bowel motility parameters (contractions-per-minute, luminal diameter, amplitude) were measured three times each in identical segments using the manual and the semiautomatic software-assisted method. The methods were compared for agreement, repeatability, and time needed for each measurement. All parameters were compared between the methods. RESULTS A total of 91 small-bowel segments were analysed. No significant intra-individual difference (p > 0.05) was found for peristaltic frequencies between the methods (mean: 4.14/min manual; 4.22/min software-assisted). Amplitudes (5.14 mm; 5.57 mm) and mean lumen diameters (17.39 mm; 14.68) differed due to systematic differences in the definition of the bowel wall. Mean duration of single measurement was significantly (p < 0.01) shorter with the software (6.25 min; 1.30 min). The scattering of repeated measurements was significantly (p < 0.05) lower using the software. CONCLUSION The software-assisted method accomplished highly reliable, fast and accurate measurement of small bowel motility. Measurement precision and duration differed significantly between the two methods in favour of the software-assisted technique.
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Affiliation(s)
- S Bickelhaupt
- Department of Radiology, University Hospital Zürich, Zürich, Switzerland
| | - J M Froehlich
- Department of Radiology, University Hospital Zürich, Zürich, Switzerland
| | - R Cattin
- University of Applied Sciences, Biel, Switzerland
| | - S Raible
- University of Applied Sciences, Biel, Switzerland
| | | | - U Bill
- SOHARD AG, Bern, Switzerland
| | - M A Patak
- Department of Radiology, University Hospital Zürich, Zürich, Switzerland; Department of Radiology, Hirslanden Clinics Zürich, Zürich, Switzerland.
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Hahnemann ML, Nensa F, Kinner S, Gerken G, Lauenstein TC. Motility mapping as evaluation tool for bowel motility: initial results on the development of an automated color-coding algorithm in cine MRI. J Magn Reson Imaging 2014; 41:354-60. [PMID: 24399576 DOI: 10.1002/jmri.24557] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 12/04/2013] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To develop and implement an automated algorithm for visualizing and quantifying bowel motility using cine magnetic resonance imaging (MRI). MATERIALS AND METHODS Four healthy volunteers as well as eight patients with suspected or diagnosed inflammatory bowel disease (IBD) underwent MR examinations on a 1.5T scanner. Coronal T2-weighted cine MR images were acquired in healthy volunteers without and with intravenous (i.v.) administration of butylscopolamine. In patients with IBD, cine MRI sequences were collected prior to standard bowel MRI. Bowel motility was assessed using an optical flow algorithm. The resulting motion vector magnitudes were presented as bowel motility maps. Motility changes after i.v. administration of butylscopolamine were measured in healthy volunteers. Inflamed bowel segments in patients were correlated with motility map findings. RESULTS The acquisition of bowel motility maps was feasible in all subjects examined. In healthy volunteers butylscopolamine led to quantitatively measurable decrease in bowel motility (mean decrease of 59%; P = 0.171). In patients with IBD, visualization of bowel movement by color-coded motility mapping allowed for the detection of segments with abnormal bowel motility. Inflamed bowel segments could be identified by exhibiting a decreased motility. CONCLUSION Our method is a feasible and promising approach for the assessment of bowel motility disorders.
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Affiliation(s)
- Maria L Hahnemann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Germany
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18
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Cullmann JL, Bickelhaupt S, Froehlich JM, Szucs-Farkas Z, Tutuian R, Patuto N, Dawson H, Patak MA. MR imaging in Crohn's disease: correlation of MR motility measurement with histopathology in the terminal ileum. Neurogastroenterol Motil 2013; 25:749-e577. [PMID: 23741963 DOI: 10.1111/nmo.12162] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 05/05/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND The objective of the study was to correlate MR-detectable motility alterations of the terminal ileum with biopsy-documented active and chronic changes in Crohn's disease. METHODS This IRB approved retrospective analysis of 43 patients included magnetic resonance enterography (MRE) and terminal ileum biopsies (<2 weeks apart). Motility was measured at the terminal ileum using coronal 2D trueFISP pulse sequences (1.5T MRI,TR 83.8,TE1.89) and dedicated motility assessment software. Motility grading (hypermotility, normal, hypomotility, complete arrest) was agreed by two experienced readers. Motility was compared and correlated with histopathology using two-tailed Kruskal-Wallis test and paired Spearman Rank-Order Correlation tests. KEY RESULTS Motility abnormalities were present in 27/43 patients: nine hypomotility and 18 complete arrest. Active disease was diagnosed on 15 biopsies: eight moderate and seven severe inflammatory activity. Chronic changes were diagnosed on 17 biopsies: 13 moderate and four severe cases. In four patients with normal motility alterations on histopathology were diagnosed. Histopathology correlated with presence (P = 0.0056 for hypomotility and P = 0.0119 for complete arrest) and grade (P < 0.0001; P = 0.0004) of motility alterations. A significant difference in the motility was observed in patients with active or chronic CD compared with patients without disease (P < 0.001; P = 0.0024). CONCLUSIONS & INFERENCES MR-detectable motility changes of the terminal ileum correlate with histopathological findings both in active and chronic CD. Motility changes may indicate the presence pathology, but do not allow differentiation of active and chronic disease.
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Affiliation(s)
- J L Cullmann
- Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital, Bern, Switzerland
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19
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van der Paardt MP, Sprengers AMJ, Zijta FM, Lamerichs R, Nederveen AJ, Stoker J. Noninvasive automated motion assessment of intestinal motility by continuously tagged MR imaging. J Magn Reson Imaging 2013; 39:9-16. [PMID: 23553805 DOI: 10.1002/jmri.24094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 02/05/2013] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate continuously tagged 3 Tesla MRI for monitoring glucagon-induced bowel motility changes in healthy volunteers. MATERIALS AND METHODS After standardized oral bowel preparation, 10 healthy volunteers underwent a free-breathing, continuously tagged three-dimensional (3D) dynamic fast-field-echo (FFE), at a 3.36 Hz sampling frequency. One milligram of glucagon was administered intravenously during data acquisition. Each dataset was divided into four temporal sets of 2 min (period 1 to 4). Taglines were tracked automatically using a scale spaced based algorithm. Assessment of global spectral resolution was performed for three frequency intervals: 0.008-0.300 Hz (motility), 0.300-0.400 Hz (breathing motion), and 0.400-0.533 Hz (higher order motion). Additional analyses were performed at fine spectral resolution in frequency bands of 0.033 Hz. Glucagon-induced motility changes were investigated by means of a motility index (spectral power normalized to the maximal spectral power per-volunteer), resulting in a range of 0 to 1 (no motion to maximal motion). Statistical comparison was done for period 1 and 4 (Wilcoxon-signed rank test). RESULTS After glucagon administration, a significant decrease in the motility index was found for the low- (0.008-0.300 Hz) (P < 0.0001) and high-frequency interval (0.400-0.533 Hz) (P < 0.0001). Around breathing motion frequencies, no decrease in motility index was detected. CONCLUSION Free-breathing, continuously tagged MR imaging is a noninvasive method for automated bowel motility assessment and allows for detection of drug-induced changes.
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Affiliation(s)
- Marije P van der Paardt
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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20
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Bickelhaupt S, Froehlich JM, Cattin R, Raible S, Bouquet H, Bill U, Patak MA. Software-assisted small bowel motility analysis using free-breathing MRI: feasibility study. J Magn Reson Imaging 2013; 39:17-23. [PMID: 23553910 DOI: 10.1002/jmri.24099] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 02/06/2013] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To validate a software prototype allowing for small bowel motility analysis in free breathing by comparing it to manual measurements. MATERIALS AND METHODS In all, 25 patients (15 male, 10 female; mean age 39 years) were included in this Institutional Review Board-approved, retrospective study. Magnetic resonance imaging (MRI) was performed on a 1.5T system after standardized preparation acquiring motility sequences in free breathing over 69-84 seconds. Small bowel motility was analyzed manually and with the software. Functional parameters, measurement time, and reproducibility were compared using the coefficient of variance and paired Student's t-test. Correlation was analyzed using Pearson's correlation coefficient and linear regression. RESULTS The 25 segments were analyzed twice both by hand and using the software with automatic breathing correction. All assessed parameters significantly correlated between the methods (P < 0.01), but the scattering of repeated measurements was significantly (P < 0.01) lower using the software (3.90%, standard deviation [SD] ± 5.69) than manual examinations (9.77%, SD ± 11.08). The time needed was significantly less (P < 0.001) with the software (4.52 minutes, SD ± 1.58) compared to manual measurement, lasting 17.48 minutes for manual (SD ± 1.75 minutes). CONCLUSION The use of the software proves reliable and faster small bowel motility measurements in free-breathing MRI compared to manual analyses. The new technique allows for analyses of prolonged sequences acquired in free breathing, improving the informative value of the examinations by amplifying the evaluable data.
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Farghal A, Kasmai B, Malcolm PN, Graves MJ, Toms AP. Developing a new measure of small bowel peristalsis with dynamic MR: a proof of concept study. Acta Radiol 2012; 53:593-600. [PMID: 22761345 DOI: 10.1258/ar.2012.110634] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Small bowel peristalsis is a complex of many individual motion elements. Although each element of peristalsis can be measured there is no current global measure of peristalsis. PURPOSE To examine the feasibility of automated computerized assessment of global small bowel motility using simple computational methods. MATERIAL AND METHODS Coronal dynamic MR images were obtained from five healthy volunteers who had fasted for 9 h and drunk 1.5 L of water. Images were taken using single breath-hold and ECG triggering. Acquisitions were repeated at 10 and 20 min after an intramuscular injection of hyoscine butylbromide. Parametric maps were generated representing the mean change in signal amplitude (MSA) per voxel for each dynamic acquisition. Two observers independently assessed thresholding for optimal segmentation of small bowel from other sources of signal. Total voxel activity (TVA) for each study was calculated as a sum of MSA per slice and whole examination and TVA profiles were generated. RESULTS Independent observations suggest that the automated segmentation method described usefully segments small bowel activity from other signal. Small bowel movement represented as TVA varied three-fold in the five volunteers and was inhibited by anti-muscarinic injection. CONCLUSION It is possible to develop a new measure, based on automated segmentation of mean signal amplitude changes, of small bowel peristalsis using dynamic MR.
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Affiliation(s)
- Aser Farghal
- Department of Radiology, Norfolk & Norwich University Hospital NHS Trust, Norwich, Norfolk
| | - Bahman Kasmai
- Department of Radiology, Norfolk & Norwich University Hospital NHS Trust, Norwich, Norfolk
| | - Paul N Malcolm
- Department of Radiology, Norfolk & Norwich University Hospital NHS Trust, Norwich, Norfolk
| | - Martin J Graves
- University Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - Andoni P Toms
- Department of Radiology, Norfolk & Norwich University Hospital NHS Trust, Norwich, Norfolk
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Heye T, Stein D, Antolovic D, Dueck M, Kauczor HU, Hosch W. Evaluation of bowel peristalsis by dynamic cine MRI: detection of relevant functional disturbances--initial experience. J Magn Reson Imaging 2012; 35:859-67. [PMID: 22267053 DOI: 10.1002/jmri.22851] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Accepted: 09/23/2011] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To investigate the diagnostic performance of a cine magnetic resonance imaging (MRI) sequence in the visualization and detection of impaired bowel peristalsis. MATERIALS AND METHODS In all, 91 consecutive patients (mean age 45 years) were prospectively examined on a 1.5 T system and stratified into a surgery group (n = 22) and a nonsurgery group (n = 69). A coronal fast imaging with steady-state precession (TrueFISP) sequence with 30 acquisitions per slice covered the abdomen in 10-15 slices each 7-12 mm thick (temporal resolution: 6-8 sec per frame). Image evaluation for reduced bowel peristalsis and relevant bowel stenosis was compared to surgical findings or clinical follow-up. RESULTS Cine MRI reached 96% accuracy (94% sensitivity; 100% specificity) in detecting a relevant reduction in bowel peristalsis and 85% of relevant stenosis was identified in the surgery group. Twenty of 69 patients of the nonsurgery group showed reduced peristalsis on cine MR which was attributed to underlying disease; 49/69 patients in this group had no findings on cine MR and were uneventfully followed up. CONCLUSION Cine MRI of the bowel provides functional information of bowel passage. The visualization of a reduction in peristalsis may improve the assessment of the functional impact of suspected bowel adhesions or stenosis. Standard bowel MR protocols can be easily complemented by cine MR, extending scan time by <4 minutes.
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Affiliation(s)
- Tobias Heye
- Diagnostische und Interventionelle Radiologie, Radiologische Klinik, Universitätsklinikum Heidelberg, Heidelberg, Germany.
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Odille F, Menys A, Ahmed A, Punwani S, Taylor SA, Atkinson D. Quantitative assessment of small bowel motility by nonrigid registration of dynamic MR images. Magn Reson Med 2012; 68:783-93. [PMID: 22234983 DOI: 10.1002/mrm.23298] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 10/05/2011] [Accepted: 10/21/2011] [Indexed: 12/12/2022]
Abstract
Evaluation of small bowel motility from two-dimensional dynamic MRI is of increasing interest for the assessment of segmental diseases such as Crohn's disease. We propose to use nonrigid image registration for automated motility analysis. Registration is particularly difficult when localized intensity changes occur (e.g., due to intraluminal flow or through-plane motion). Therefore, displacements were extracted using a joint registration and modeling of intensity changes. Results were analyzed in 10 patients with known or suspected Crohn's disease. Bowel wall displacements were assessed by tracking bowel cross-sectional markers over time. Automated tracking with the proposed technique was in good agreement with manual tracking (similar bias, improved standard deviations). The ability to quantify different grades of bowel motility was investigated by comparing direct motion measures (i.e., changes in bowel cross-sectional diameter or area) and various parametric maps, e.g., based on the Jacobian of the measured displacements with expert grading. Among these measures, the standard deviation over time of the Jacobian was the best at predicting grades from 1 (moving normally) to 4 (not moving at all) in 50 bowel regions with normal and pathologically reduced motility, yielding 93% correct classification with a 1-class tolerance (i.e., same score as the expert ± 1).
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Affiliation(s)
- Freddy Odille
- Centre for Medical Image Computing, University College London, London, United Kingdom
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Abstract
BACKGROUND Magnetic resonance imaging (MRI) is a useful technique for evaluating gastrointestinal (GI) motor functions because it provides multi-planar imaging capability, high imaging speed, good spatial resolution and excellent soft tissue contrast. Moreover, multiple parameters of GI function can be assessed non-invasively during a single study. PURPOSE This critical review of the literature discusses the strengths and limitations of MRI for evaluating GI motor functions.
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Affiliation(s)
- L Marciani
- Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Nottingham University Hospitals, University of Nottingham, Nottingham, UK.
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Gutzeit A, Patak MA, von Weymarn C, Graf N, Doert A, Willemse E, Binkert CA, Froehlich JM. Feasibility of small bowel flow rate measurement with MRI. J Magn Reson Imaging 2010; 32:345-51. [DOI: 10.1002/jmri.22254] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Froehlich JM, Waldherr C, Stoupis C, Erturk SM, Patak MA. MR motility imaging in Crohn's disease improves lesion detection compared with standard MR imaging. Eur Radiol 2010; 20:1945-51. [PMID: 20379822 DOI: 10.1007/s00330-010-1759-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 01/12/2010] [Accepted: 02/11/2010] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate retrospectively in patients with Crohn's disease (CD) if magnetic resonance (MR) motility alterations correlate with CD typical lesions leading to an increased detection rate. METHODS Forty patients with histologically proven CD underwent MR enterography (MRE), including coronal cine sequences (cine MRE), in addition to the standard CD MR protocol. Two blinded readings were performed with and without cine MRE. Locations presenting motility alterations on the cine sequences were analysed on standard MRE for CD-related lesions. This was compared with a second reading using the standard clinical MRE protocol alone. RESULTS The number of lesions localised by cine MRE and identified on standard MRE compared with standard MRE alone were 35/24 for wall thickening (p = 0.002), 24/20 for stenoses (p = 0.05), 17/11 for wall layering (p = 0.02), 5/3 for mucosal ulcers (p = 0.02) and 21/17 for the comb sign (p = 0.05). Overall, cine MRE detected 35 more CD-specific findings than standard MRE alone (124/89; p = 0.007) and significantly more patients with CD-relevant MR findings (34/28; p = 0.03). CONCLUSION CD lesions seem to be associated with motility changes and this leads to an increased lesion detection rate compared with standard-MRE imaging alone.
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Affiliation(s)
- Johannes M Froehlich
- Institute of Diagnostic, Interventional and Pediatric, Radiology, Inselspital, University Hospital, Bern, Switzerland
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Froehlich JM, Daenzer M, von Weymarn C, Erturk SM, Zollikofer CL, Patak MA. Aperistaltic effect of hyoscine N-butylbromide versus glucagon on the small bowel assessed by magnetic resonance imaging. Eur Radiol 2009; 19:1387-93. [PMID: 19190916 DOI: 10.1007/s00330-008-1293-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Revised: 12/03/2008] [Accepted: 12/13/2008] [Indexed: 12/13/2022]
Abstract
The aim of this prospective study was to compare the intraindividual aperistaltic effect of 40 mg hyoscine N-butylbromide (HBB/Buscopan) with that of 1 mg glucagon on small bowel motility by using magnetic resonance imaging (MRI). Ten healthy volunteers underwent two separate 1.5-T MRI studies (HBB/glucagon) after a standardized oral preparation with an aqueous solution of Gd-DOTA and ispaghula (Metamucil). A 2D T1-w GRE sequence was acquired (TR 2.7 ms/TE 1.3 ms, temporal resolution 0.25 s) before and after intravenous (i.v.) drug administration and motility was followed over 1 h. On the resulting images the cross-sectional luminal diameters were assessed and plotted over time. Baseline motility frequency, onset of aperistalsis, duration of arrest, reappearance of motility and return to normal motility were analysed. Significant differences regarding reliability and duration of aperistalsis were observed. In the HBB group aperistalsis lasted a mean of 6.8 +/- 5.3 min compared with 18.3 +/- 7 min after glucagon (p < 0.0001). In 50% of cases HBB did not accomplish aperistalsis, whereas glucagon always succeeded (p = 0.05). There were no significant differences in terms of baseline and end frequencies for the onset of aperistalsis (22.2 +/- 37.5 s HBB/13.4 +/- 9.2 s glucagon, p = 0.1), nor for the return to normal motility. Arrest of small bowel motion is achieved more reliably and lasts significantly longer after i.v. administration of 1 mg glucagon compared with 40 mg HBB.
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Abstract
PURPOSE OF REVIEW To review recently published studies presenting novel and relevant information on small intestinal motility. RECENT FINDINGS The reviewed studies covered a variety of topics with several themes emerging. Our understanding of the influence of systemic disorders, intestinal and extraintestinal infections and enteric bacteria on digestive motor function continues to involve. Elegant and important new studies have been published that better define the physiology of intestinal gas handling along with the genesis of symptoms commonly attributed to excessive intestinal gas. While interest in small intestinal bacterial overgrowth in irritable bowel syndrome continues, the utility and specificity of lactulose hydrogen breath testing is yet again questioned and further data are needed before the practice of routinely prescribing antibiotics to patients with irritable bowel syndrome can be endorsed. SUMMARY Small intestinal motility remains an understudied area. Recent publications provide additional new information related to physiology and pathophysiology of small bowel motility. These findings should be of interest to clinician and investigator alike.
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