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-metry and impedance. Methods Patients who underwent real-time MRI and pH-metry between 2015-2018 were included in this retrospective study. Real-time MRI at 3 Tesla 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-metry to assess acidic reflux (following Lyon Consensus guidelines) and to impedance to assess non-acidic reflux. A standard 2 × 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 minutes. On real-time MRI, reflux was evident in 60 patients (66%). pH-metry revealed reflux in 41 patients (45%), and impedance in 54 patients (59%). Compared to pH-metry and impedance, real-time MRI sensitivity was 0.78 (95% 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-metry and impedance might be considered.