Observation of gastro-esophageal reflux by MRI: a feasibility study

To evaluate the feasibility of detecting and measuring gastro-esophageal reflux (GER) with esophageal MR fluoroscopy in patients suffering from heartburn.

Twenty patients with heartburn underwent esophageal MR fluoroscopy. The T1-FFE sequence was applied for MR imaging. We examined the frequency and the level of GER on MR images. Based on the MRI observations, patients were classified into four MRI grades (grade 1-4). Endoscopic findings were categorized into five grades (grade 0 to D). The overall MRI grade, Carlsson's questionnaire score, and endoscopic findings were compared.

GER was observed with MR fluoroscopy in 19 of 20 patients. GER was observed only several times in three patients, and much more frequently in the remaining 16 patients. Elevated levels of GER reached the lower, middle-to-upper esophagus, and the hypopharynx. The observed MRI grades were grade 1 = 1 patient, grade 2 = 3 patients, grade 3 = 2 patients, and grade 4 = 13 patients. There was no statistical correlation between the questionnaire score and the MRI grade. Also, there was no correlation between the grade of endoscopic findings and MRI grade. Six patients demonstrated continuous reflux on MRI did not show mucosal injury at endoscopy.

Esophageal MR fluoroscopy may be a useful diagnostic tool for GERD for its ability to show GER, even in patients with no mucosal injury, and for suggesting the cause of the reflux.