Magnetic resonance imaging during upper GI endoscopy: Technical considerations and clinical feasibility

Objective: To obtain high resolution magnetic resonance (MR) images of the intramural and extramural extent of lesions visualized during upper gastrointestinal endoscopy. Subjects and methods: Eight patients, four male and four female aged 50 to 77 years (mean 65.6 years), were studied using an endoscope that was specially constructed for use in an MR scanner using non-ferromagnetic components. A 5cm long saddle geometry receiver coil mounted on a Delrin(TM) former and equal in diameter to the endoscope was reverse threaded through the biopsy channel. The coil and endoscope were then inserted under direct vision into the oesophagus. After routine visual inspection the coil was placed adjacent to the site of pathology. Tt-weighted spin-echo images and radiofrequency spoiled gradient-echo images with a segmented k-space acquisition were obtained with ECG gating. Results: In one patient with an oesophageal tumour extensive mediastinal involvement was seen. One patient with reflux oesophagitis showed some mural thickening whilst another did not. Following fundoplication, the position and extent of the surgical reconstruction was demonstrated in one patient. After banding of oesophageal varices in another patient the absence of varices around the lower oesophagus was confirmed. Extensive varices were seen around the splenic hilum. Conclusion: This pilot study demonstrates that MR imaging using a surface coil placed within the gastrointestinal tract during an endoscopy is feasible and the mural and extramural extent of lesions can be visualized thus providing a useful adjunct to upper gastrointestinal endoscopy.