Performance of a new natural oral contrast agent (LumiVision®) in dynamic MR swallowing

Abstract

Objectives: To evaluate image quality by first use of LumiVision® in dynamic MR swallowing, a contrast medium consisting of biological substances versus a gadolinium-buttermilk mixture in patients who underwent Nissen fundoplication due to gastroesophageal reflux disease (GERD).

Methods: The protocol of this retrospective study was approved by the local Institutional Review Board. A hundred twenty-nine patients (146 examinations) underwent a dynamic MR swallowing study (at 1.5 T or 3.0 T) and received an oral contrast agent. Two readers evaluated the distention of the esophagus, contrast, and traceability of the bolus in a 3-point scale. A steady-state coherent sequence (B-FFE, TrueFISP) was used. The patients were divided into 3 different groups: 53 patients received gadolinium chelate (Dotarem®)-buttermilk mixture (GBM) in a dilution of 1:40 as an oral contrast agent; 44 patients received LumiVision® water mixture (LWM) in a dilution of 1:1 and 49 patients received LumiVision® (L) undiluted.

Results: GBM showed significantly better results in overall evaluation for both readers in contrast to LWM (p = .003, p = .002). L also reached significantly better results in overall evaluation than LWM in both readers (p = .004, p = .042). There was no significant difference in the overall evaluation between L and GBM (p = .914, p = .376).According to Landis and Koch, interobserver agreement was "substantial" (Cohen's kappa = 0.738) between both readers.

Conclusion: LumiVision® undiluted showed equal image quality compared to gadolinium-buttermilk mixture. The constellation of LumiVision® water mixture led to a clearly negative result in relation to the image quality compared to LumiVision® undiluted. Therefore, oral ingestion of LumiVision® undiluted is recommended for MR swallowing examinations.

Key points: • LumiVision® undiluted shows significantly better image quality in comparison to LumiVision® diluted in oral application in swallowing MRI. • LumiVision® undiluted shows equal image quality in comparison to gadolinium-buttermilk mixture in oral application. • Oral ingestion of LumiVision® undiluted can replace gadolinium-buttermilk mixture in oral MR examinations.

Keywords: Esophagus; Fundoplication, contrast agent; Magnetic resonance imaging.

Fig. 1

Postoperative appearance after Nissen fundoplication on MRI in three different patients. Contrast medium passes through the esophagus (arrows) and shows excellent distention of the esophagus with gadolinium-buttermilk mixture on a 3T MRI (a), as well as with LumiVision® undiluted (b) in the coronal view on a 1.5 T MRI. Poor distention is seen with LumiVision® water mixture on a 1.5 T MRI (c). In the first patient (a), a telescope phenomenon could be seen (big arrows). Parts of the stomach have been slipped through the intact wrap into the thorax

Fig. 2

Contrast of the different contrast media in three different patients. TrueFisp sequences in the coronal view were performed to demonstrate the esophagus. All examinations were performed on a 3T MRI. An excellent contrast of the esophagus to the surrounding structures was reached with gadolinium-buttermilk mixture (a) as well as with LumiVision® undiluted (b). The patient with swallowed LumiVision® water mixture shows a bad contrast of the esophagus (c). In this patient, the wrap was ruptured and a big part of the stomach was migrated into the thorax, which is called Re-Hernia (big arrows)

Fig. 3

Overall ratings. The overall ratings were nearly equal in both readers with regard to the three different contrast agent groups