title: MRI patterns of Nissen fundoplication: normal appearance and mechanisms of failure.
abstract: OBJECTIVE
  The purpose of the study was to assess the role of MR fluoroscopy in the evaluation of post-surgical conditions of Nissen fundoplication due to gastro-oesophageal reflux disease (GERD).
  
  
  METHODS
  A total of 29 patients (21 patients with recurrent/persistent symptoms and eight asymptomatic patients as the control group) underwent MRI of the oesophagus and gastro-oesophageal junction (GEJ) at 1.5 T. Bolus transit of a buttermilk-spiked gadolinium mixture was evaluated with T2-weighted half-Fourier acquisition single-shot turbo spin-echo (HASTE) and dynamic gradient echo sequences (B-FFE) in three planes. The results of MRI were compared with intraoperative findings, or, if the patients were treated conservatively, with endoscopy, manometry, pH-metry and barium swallow.
  
  
  RESULTS
  MRI was able to determine the position of fundoplication wrap in 27/29 cases (93% overall accuracy) and to correctly identify 4/6 malpositions (67%), as well as all four wrap disruptions. All five stenoses in the GEJ were identified and could be confirmed intraoperatively or during dilatation. MRI correctly visualized three cases with motility disorders, which were manometrically confirmed as secondary achalasia. Three patients showed signs of recurrent reflux without anatomical failure.
  
  
  CONCLUSIONS
  MRI is a promising diagnostic method to evaluate morphologic integrity of Nissen fundoplication and functional disorders after surgery.
  
  
  CONCLUSIONS
  MRI offers simultaneous morphological and functional imaging in one diagnostic method. MR fluoroscopy offers the possibility to identify the wrap position. MRI enables a non-invasive diagnosis, providing detailed information for the surgeon.
authors: Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria, christiane.kulinna-cosentini@meduniwien.ac.at.
authors: Christiane
authors: C
authors: Kulinna-Cosentini
authors: Wolfgang
authors: W
authors: Schima
authors: Ahmed
authors: A
authors: Ba-Ssalamah
authors: Enrico P
authors: EP
authors: Cosentini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition / Q000502:physiology; D016099:Endoscopy, Gastrointestinal; D015154:Esophageal Motility Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D004943:Esophagogastric Junction / Q000473:pathology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D011183:Postoperative Complications; D011312:Pressure; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors; D017211:Treatment Failure