Simultaneous assessment of colon motility in children with functional constipation by cine-MRI and colonic manometry: a feasibility study

Abstract

Background: Colonic manometry is the current reference standard for assessing colonic neuromuscular function in children with intractable functional constipation (FC). Recently, cine magnetic resonance imaging (cine-MRI) has been proposed as a non-invasive alternative. We compared colonic motility patterns on cine-MRI with those obtained by manometry in children, by stimulating high-amplitude propagating contractions (HAPCs) with bisacodyl under manometric control while simultaneously acquiring cine-MRI.

Methods: After Institutional Review Board approval, adolescents with FC scheduled to undergo colonic manometry were included. A water-perfused 8-lumen catheter was used for colonic manometry recordings. After an intraluminal bisacodyl infusion, cine-MRI sequences of the descending colon were acquired for about 30 min simultaneously with colonic manometry. Manometry recordings were analysed for HAPCs. MRI images were processed with spatiotemporal motility MRI techniques. The anonymised motility results of both techniques were visually compared for the identification of HAPCs in the descending colon.

Results: Data regarding six patients (three males) were analysed (median age 14 years, range 12-17). After bisacodyl infusion, three patients showed a total of eleven HAPCs with colonic manometry. Corresponding cine-MRI recorded high colonic activity during two of these HAPCs, minimal activity during seven HAPCs, while two HAPCs were not recorded. In two of three patients with absent HAPCs on manometry, colonic activity was recorded with cine-MRI.

Conclusions: Simultaneous acquisition of colonic cine-MRI and manometry in children with FC is feasible. Their motility results did not completely overlap in the identification of HAPCs. Research is needed to unravel the role of cine-MRI in this setting.

Keywords: Child; Colon; Constipation; Magnetic resonance imaging (cine); Manometry.

Fig. 1

Study setup simultaneous motility recordings using cine magnetic resonance imaging (MRI) and colonic manometry. Colonic manometry catheter was connected to a pneumohydraulic pump outside the MRI scanner room. Reprint with permission from [13]

Fig. 2

Simultaneous colonic manometry and cine magnetic resonance imaging (cine-MRI) motility results. The figure displays: (a) a sagittal view of the child showing the region of interest in the descending colon; (b) the results of about 30 min of cine-MRI colonic activity. Recording time in minutes is displayed on the x-axis. Colonic activity is reported on the y-axis, with red colours representing a small diameter (contraction) and blue colours no change in diameter; and (c) the about 30 min of colonic manometry recordings with an overlay of simultaneous cine-MRI results as shown in b, to allow for a visual comparison of high-amplitude propagating contractions (HAPCs). The x-axis displays the time from the start of simultaneous cine-MRI imaging (0 min) to the termination of the cine-MRI recordings (about 30 min). The y-axis displays the manometric channels in the descending colon with pressure changes (in mmHg), overlapping the cine-MRI motility results as shown in b. ± Patient with caecostomy in place, * HAPC