The efficacy of pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography.

Sheryl Mohabir,Matthew D.M Goodier,Rubeshan Perumal,Richard D Pitcher

doi:10.4102/sajr.v24i1.1875

Abstract

BackgroundDuring magnetic resonance cholangiopancreatography (MRCP), the pancreatobiliary ducts can be obscured by the high-intensity signal from the stomach and duodenum. Pineapple juice may be an alternative to commercially available negative contrast agents, but has not been evaluated locally.ObjectivesTo evaluate the efficacy of a local, off-the-shelf pineapple juice preparation as a negative oral contrast agent for MRCP.MethodAn observational, analytical study was conducted during January–December 2017. A 1.5 Tesla MRCP sequence was performed immediately before and after ingestion of 250 mL of a local, commercially-available pineapple juice preparation. Image evaluation was performed by two radiologists with independent, blind assessment of gastric/duodenal signal intensity and biliary /pancreatic duct visibility, before and after pineapple juice.ResultsFifty adult patients (F = 44, 88%) with median age 44 years (IQR: 34.75, 57) were included. After pineapple juice administration, there was significant measured (1661.51 vs. 1409.94, p < 0.01) and perceived (2.16 vs. 2.72, p < 0.01) duodenal signal reduction but no significant change in measured (1081.17 vs. 1044.38, p = 0.34) or perceived (2.73 vs. 2.84, p = 0.14) gastric signal intensity. Visibility of the common bile duct was significantly improved (3.67 vs. 3.86, p < 0.01), whilst that of the main pancreatic duct showed no significant change (2.92 vs. 2.86, p = 0.44).ConclusionThe local pineapple juice preparation used in this study is an effective, affordable and natural negative oral contrast agent for enhancement of MRCP images, and specifically improves visualisation of the common bile duct.

Highlights

Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive technique for imaging the biliary and pancreatic ducts.[1]
As MRCP has diagnostic accuracy comparable to endoscopic retrograde cholangiopancreatography (ERCP), it is preferred for initial pancreaticobiliary investigation, with ERCP reserved for therapeutic interventions and biopsy.[6,7,8,9,10,11,12]
Patients are fasted before the examination and a negative oral contrast agent may be administered to further suppress signal from these structures.[16]

Summary

Introduction

Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive technique for imaging the biliary and pancreatic ducts.[1]. Magnetic resonance cholangiopancreatography utilises heavily T2-weighted, mainly coronal, maximum intensity projections (MIP), similar to conventional cholangiopancreatography.[13] the high-intensity signal from adjacent gastric and duodenal fluids may obscure the bile and pancreatic ducts, limiting diagnostic accuracy.[14,15] To overcome this, patients are fasted before the examination and a negative oral contrast agent may be administered to further suppress signal from these structures.[16] Negative contrast agents use the paramagnetic http://www.sajr.org.za. During magnetic resonance cholangiopancreatography (MRCP), the pancreatobiliary ducts can be obscured by the high-intensity signal from the stomach and duodenum. Pineapple juice may be an alternative to commercially available negative contrast agents, but has not been evaluated locally

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