Gastric polypoid lesions detected on magnetic resonance cholangiopancreatography

Background: On magnetic resonance cholangiopancreatography (MRCP) using a negative oral contrast agent, the gastric lumen appear dark, and gastric polypoid lesions can be seen. To our knowledge, there are no reports examining gastric polypoid lesions detected on MRCP.We exained the characteristics of gastric polypoid lesions detected on MRCP and discussed the management of the lesions.Material and Methods: MRCP images using a negative oral contrast agent were retrospectively evaluated in 1128 cases, and gastric polypoid lesions detected were investigated.Results: Gastric polypoid lesions were detected in 17 of the 1128 cases (1.5%) on MRCP. The mean patient age and gender were 66.7 years (range: 48-85 years) and 7 males / 10 females. A single lesion was detected in 4 cases, 2 to 4 lesions were detected in 6 cases, 5 to 10 lesions in 3 cases, and 11 or more in 4 cases. In 4 cases, the upper, middle, and lower portions of the stomach were occupied with polypoid lesions, in 4 cases, the upper and middle portions were occupied, in 1 case, the middle and lower portions were occupied, and in 8 cases, only the upper portion was occupied. One lesion was detected in 4 cases, 2 to 4 lesions were detected in 6 cases, 5 to 10 lesions in 3 cases, and 11 or more in 4 cases. The mean maximum diameter of the polypoid lesions was 7.8 mm (range: 4-16 mm). An upper endoscopy and forceps biopsy were performed in 9 of the 17 cases. The histological diagnosis was fundic gland polyps in 6 cases and hyperplastic polyps in 3 cases.Conclusion: Gastric polypoid lesions can rarely be detected on MRCP. The polypoid lesions were histologically fundic gland polyps or hyperplastic polyps. In the future, we will prospectively review more cases and examine indication of upper gastrointestinal endoscopy to gastric polypoid lesions detected on MRCP.

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

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.

A novel food-based foam as oral contrast agent with negative Hounsfield units for demarcation of small bowel loops on abdominal CT: tolerability and bowel distension in 25 volunteers

Background Diseases of the bowel are not always displayed on conventional abdominal computed tomography (CT). The studied oral contrast agent aims to improve this. Purpose To investigate whether the use of a novel oral contrast for abdominal CT enables the same diagnostic advantages as seen in magnetic resonance imaging (MRI). Material and Methods Twenty-five consented volunteers drank up to 1400 mL of a stable, drinkable foam. Comments on acceptance and side effects were noted immediately and 24 h later. Foam palatability was documented through interviews, and distribution in the small bowel by Hounsfield units from the CT software. The CT results were compared with age- and sex-matched controls, pretreated according to routine. A non-enhanced abdominal CT protocol of lowest possible radiation dose was used. External referees evaluated all data obtained. Results Foam was considered odd to swallow, and fullness was reported by all volunteers after 950 mL. Five had difficulties in drinking the last 320 mL and two abstained from it. All adverse symptoms were mild. The distribution in the small bowel was on par with standard agents. Foam density revealed stability with intraluminal values of around –550 HU from stomach to terminal ileum, satisfying the requirement of a great bowel lumen-to-wall contrast. External reviewers re-evaluated all our data, and one predicted the foam to offer a potential for improved diagnostics. Conclusion A CT true-negative bowel filling agent was formulated, with high acceptance, few side effects, and a potential to mimic T1-weighted MRI images.