Cine MR Enterography Grading of Small Bowel Peristalsis: Evaluation of the Antiperistaltic Effectiveness of Sublingual Hyoscyamine Sulfate

Abstract

To use a cine balanced steady-state free precession magnetic resonance enterography (cine MRE) pulse sequence to assess the effectiveness of a sublingual (SL) antiperistaltic agent, hyoscyamine sulfate. Institutional review board approval was granted with an exemption for informed consent in this Health Insurance Portability and Accountability Act-compliant, retrospective, single-institution study. Of the 288MRE examinations performed between October 1, 2007 and January 15, 2011, 92 using SL hyoscyamine sulfate for antiperistalsis were included for review, each with cine MRE before and after medication. These 184 cine MRE data sets were randomized, blinded for treatment, and independently reviewed by five attending abdominal radiologists, who rated the degree of whole abdomen bowel motility on each cine MRE data set on a 5-point scale. Pre- and postmedication mean peristalsis ratings, standard deviation, mean difference, and treatment effect sizes werecalculated. A repeated measures analysis of variance test was performed using a significance threshold of P=.05. Interobserver reliabilities were also calculated. Mean peristalsis ratings ranged 2.63-3.34 and 2.36-3.03, before and after medication administration, respectively. The mean differences ranged from 0.22 to 0.46, which are treatment effect sizes of 0.20 to 0.37. The decrease in peristalsis observed by the five reviewing radiologists after SL hyoscyamine sulfate administration was significant (df = 1/182, f=7.35, P<.01). The interobserver reliabilities were 0.34 for the pretest and 0.33 for the posttest. Although cine MRE sequences show decreased bowel peristalsis after the use of SL hyoscyamine sulfate, the small size ofthe observed treatment effect is likely insufficient to justify its use for MRE.