title: Magnetic resonance imaging for simultaneous morphological and functional evaluation of esophageal motility disorders.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the feasibility and safety of esophageal functional magnetic resonance imaging (fMRI) for the diagnosis of achalasia.
  
  
  METHODS
  Eleven patients with suspected achalasia and three normal subjects underwent fMRI while swallowing clear liquid with original sequences; "T2-weighed single-shot fast spin-echo" and "Fast Imaging Employing Steady-state Acquisition". The fMRI-based diagnosis was compared with that based on manometry. The luminal fluctuation index (LFI) and Dd/Ds ratio were used for the objective evaluation of the esophageal peristalsis and relaxation of the lower esophageal sphincter (LES).
  
  
  RESULTS
  Functional MRI showed a dilated tortuous esophagus with no tumor, poor clearance, simultaneous waves, aperistalsis, and impaired LES relaxation in all but one case, allowing the diagnosis of achalasia with accuracy similar to that of manometry. The LFI (median 0.08, range 0.03-0.25) and Dd/Ds ratio (1.40, 1.0-2.3) of the patient group were significantly lower than those of the normal subjects [1.50, 2.32-4.05, and 2.59 (2.32-4.05)]. No severe adverse events directly related to fMRI were noted.
  
  
  CONCLUSIONS
  Using our protocol, fMRI was considered to be safe and feasible for the diagnosis of achalasia. Given the widespread use of MRI, esophageal fMRI, which does not require exposure to radiation, could be a potentially useful diagnostic tool for patients with esophageal motility disorders.
authors.affiliation: Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2 E-2 Yamadaoka, Suita, Osaka, 565-0871, Japan, ymiyazaki02@gesurg.med.osaka-u.ac.jp.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Miyazaki
authors.forename: Kiyokazu
authors.initials: K
authors.lastname: Nakajima
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Sumikawa
authors.forename: Makoto
authors.initials: M
authors.lastname: Yamasaki
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Takahashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miyata
authors.forename: Shuji
authors.initials: S
authors.lastname: Takiguchi
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Kurokawa
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Tomiyama
authors.forename: Masaki
authors.initials: M
authors.lastname: Mori
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
mesh_terms: D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000473:pathology / Q000503:physiopathology; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000473:pathology* / Q000503:physiopathology; D004947:Esophagus / Q000473:pathology* / Q000503:physiopathology*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010528:Peristalsis