Abstract
PurposeTo assess the esophagogastric junction (EGJ) on real-time MRI and compare imaging parameters to EGJ morphology on high-resolution manometry (HRM).MethodsA total of 105 of 117 eligible patients who underwent real-time MRI and high-resolution manometry for GERD-like symptoms between 2015 and 2018 at a single center were retrospectively evaluated (male n = 57; female n = 48; mean age 52.5 ± 15.4 years). Real-time MRI was performed at a median investigation time of 15 min (1 frame/40 ms). On HRM, EGJ morphology was assessed according to the Chicago classification of esophageal motility disorders. Real-time MRI was performed at 3 T using highly undersampled radial fast low-angle shot acquisitions with NLINV image reconstruction. A 10 mL pineapple juice bolus served as oral contrast agent at supine position. Real-time MRI films of the EGJ were acquired during swallowing events and during Valsalva maneuver. Anatomic and functional MRI parameters were compared to EGJ morphology on HRM.ResultsOn HRM, n = 42 patients presented with EGJ type I (40.0%), n = 33 with EGJ type II (31.4%), and n = 30 with EGJ type III (28.6%). On real-time MRI, hiatal hernia was more common in patients with EGJ type III (66.7%) than in patients with EGJ type I (26.2%) and EGJ type II (30.3%; p < 0.001). Sliding hiatal hernia was more frequent in patients with EGJ type II (33.3%) than in patients with EGJ type III (16.7%) and EGJ type I (7.1%; p = 0.017). The mean esophagus–fundus angle of patients was 85 ± 31° at rest and increased to 101 ± 36° during Valsalva maneuver.ConclusionReal-time MRI is a non-invasive imaging method for assessment of the esophagogastric junction. Real-time MRI can visualize dynamic changes of the EGJ during swallowing events.
Highlights
Gastroesophageal reflux disease (GERD) is defined as reflux of gastric contents into the distal esophagus, which may yield relevant clinical symptoms or complications [1]
The gender distribution was balanced with 48 females (45.7%) and 57 males (54.3%)
On real-time MRI, hiatal hernias were more common in patients with esophagogastric junction (EGJ) type III (n = 20; 66.7%) compared to patients with EGJ type I (n = 11; 26.2%) and EGJ type II (n = 10; 30.3%) (p < 0.001)
Summary
Gastroesophageal reflux disease (GERD) is defined as reflux of gastric contents into the distal esophagus, which may yield relevant clinical symptoms or complications [1]. Japanese Journal of Radiology intrinsic lower esophageal sphincter (LES), the sling fibers of the gastric cardia and the extrinsic crural diaphragm, which together form an intricate sphincter complex [2, 3]. The anatomic conformation of the sling fibers constitutes a flap valve mechanism that improves the barrier function [4, 5]. Transient relaxations of the lower esophageal sphincter complex (TLESRs) have been identified as the main cause of EGJ dysfunction for gastroesophageal reflux [6, 7]. Hiatal hernias may impair the sphincter function of the crural diaphragm and sling fibers [8, 9]. HRM does not provide direct anatomic delineation of the esophagogastric sphincter complex
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