Real-time MRI for dynamic assessment of gastroesophageal reflux disease: Comparison to pH-metry and impedance

Ali Seif Amir Hosseini, Johannes Uhlig, Ulrike Streit, Nina Gliem, Edris Wedi, Volker Ellenrieder, Michael Ghadimi, Saheeb Ahmed, Martin Uecker, Jens Frahm, Joachim Lotz, Lorenz Biggemann

Research output: Contribution to journalArticlepeer-review


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.
Patients who underwent real-time MRI and pH-metry between 2015–2018 were included in this retrospective study. Real-time MRI at 3 T 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.
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 min. 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).
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.
Original languageEnglish
Article number108856
JournalEuropean Journal of Radiology
Publication statusPublished - Apr 2020
Externally publishedYes


  • Gastroesophageal reflux disease
  • GERD
  • Magnetic resonance imaging
  • Esophageal pH recording
  • Impedance


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