Real-time MRI for Dynamic Assessment of Gastroesophageal Reflux Disease: Comparison to Ph-Metry and Impedance

Purpose: To evaluate the diagnostic potential of real-time MRI for dynamic assessment of gastroesophageal reflux in patients with GERD (gastroesophageal reflux disease)-like symptoms compared to pH-merry and impedance. Methods: Patients who underwent real-time MRI and pH-merry between 2015-2018 were included in this retrospective study. Real-time MRI at 3 T was achieved by undersampled radial FLASH acquisitions with iterative image reconstruction by NLINV. Real-time MRI visualized transit of pineapple juice through the gastroesophageal junction and during Valsalva maneuver. MRI results were compared to 24 h pH-merry to assess acidic reflux (following Lyon Consensus guidelines) and to impedance to assess non-acidic reflux. A standard 2 x 2 table was chosen to calculate diagnostic performance. Results: 91/93 eligible patients fulfilled inclusion criteria (male n = 49; female n = 42; median age 55 y). All MRI studies were successfully completed without adverse events at a mean examination time of 15 min. On realtime MRI, reflux was evident in 60 patients (66 %). pH-merry revealed reflux in 41 patients (45 %), and impedance in 54 patients (59 %). Compared to pH-merry and impedance, real-time MRI sensitivity was 0.78 (95 0 /0 CI: 0.66-0.87), specificity 0.67 (95 % CI: 0.45-0.84) and PPV 0.87 (95 % CI: 0.75-0.94). Conclusion: Real-time MRI is an imaging method for assessment of gastroesophageal reflux in patients with GERD-like symptoms. Considering its high positive predictive value, real-time MRI can accurately identify patients in which further invasive testing with pH-merry and impedance might be considered.