Novel MRI tests of orocecal transit time and whole gut transit time: studies in normal subjects

G Chaddock, C Lam, C L Hoad, C Costigan, E F Cox, E Placidi, I Thexton, J Wright, P E Blackshaw, A C Perkins, L Marciani, P A Gowland, R C Spiller, G Chaddock, C Lam, C L Hoad, C Costigan, E F Cox, E Placidi, I Thexton, J Wright, P E Blackshaw, A C Perkins, L Marciani, P A Gowland, R C Spiller

Abstract

Background: Colonic transit tests are used to manage patients with Functional Gastrointestinal Disorders. Some tests used expose patients to ionizing radiation. The aim of this study was to compare novel magnetic resonance imaging (MRI) tests for measuring orocecal transit time (OCTT) and whole gut transit time (WGT), which also provide data on colonic volumes.

Methods: 21 healthy volunteers participated. Study 1: OCTT was determined from the arrival of the head of a meal into the cecum using MRI and the Lactose Ureide breath test (LUBT), performed concurrently. Study 2: WGT was assessed using novel MRI marker capsules and radio-opaque markers (ROMs), taken on the same morning. Studies were repeated 1 week later.

Key results: OCTT measured using MRI and LUBT was 225 min (IQR 180-270) and 225 min (IQR 165-278), respectively, correlation r(s) = 0.28 (ns). WGT measured using MRI marker capsules and ROMs was 28 h (IQR 4-50) and 31 h ± 3 (SEM), respectively, correlation r(s) = 0.85 (p < 0.0001). Repeatability assessed using the intraclass correlation coefficient (ICC) was 0.45 (p = 0.017) and 0.35 (p = 0.058) for MRI and LUBT OCTT tests. Better repeatability was observed for the WGT tests, ICC being 0.61 for the MRI marker capsules (p = 0.001) and 0.69 for the ROM method (p < 0.001) respectively.

Conclusions & inferences: The MRI WGT method is simple, convenient, does not use X-ray and compares well with the widely used ROM method. Both OCTT measurements showed modest reproducibility and the MRI method showed modest inter-observer agreement.

Keywords: MRI; correlation; marker capsule; transit time.

© 2013 The Authors. Neurogastroenterology & Motility Published by John Wiley & Sons Ltd.

Figures

Figure 1
Figure 1
13C breath excretion curve. Example 13C breath excretion curve from Lactose Ureide Breath Test in one healthy volunteer with indication of the orocecal transit time (OCTT). The OCTT is taken as the time at which there is an increase in breath 13C which is 2.5 times the SD of all previous points above the running average of all previous points.
Figure 2
Figure 2
Magnetic resonance imaging (MRI) marker capsule. Example of a capsule which consists of two polyoxymethylene half shells glued together, and hand filled with 0.4 mL 15 μM Gadoteric acid (Gd-DOTA). Leakage tests performed on 20% of each batch using a spectrophotometer. Capsules have the dimensions of 20 × 7 mm.
Figure 3
Figure 3
Maximum intensity projection (MIP) magnetic resonance imaging (MRI) image. Showing five MRI marker capsules in the colon (indicated by close arrows). Images created using water only images acquired using the T1 weighted multi-echo FFE pulse sequence. Such images were used to locate the number and position of capsules remaining at 24 h to calculate a whole gut transit time.
Figure 4
Figure 4
Segmented Colon. Showing the segmented colon used to score the MRI marker capsules at 24 h, where 0 = not found (presumed to be excreted), 1 = sigmoid and rectum, 2 = descending colon, 3 = left transverse colon, 4 = right transverse colon, 5 = upper ascending colon, 6 = lower ascending colon, 7 = small bowel.
Figure 5
Figure 5
(A) Correlation between Lactose Ureide Breath Test (LUBT) and magnetic resonance imaging (MRI). Scatter plot with line of identity, comparing the orocecal transit time (OCTT) measured using the LUBT and MRI. The degree of correlation was assessed using the Spearman's rank correlation coefficient test, and we report a Spearman's r-value of 0.28 (not significant). (B) Agreement between OCTT measurements. Bland-Altman plot showing the average OCTT measured using the LUBT and MRI on the x-axis, and the difference between the OCTT measured using the two methods on the y-axis. This plot shows that there was a mean difference of −7.32 min between the LUBT and MRI (middle dotted line), with the limits of agreement ranging from 183.0 to −197.6 min (upper and lower dotted lines).
Figure 6
Figure 6
(A) Correlation between radio-opaque markers (ROM) and magnetic resonance imaging (MRI) markers. Plot comparing the whole gut transit time (WGT) measured using ROMs and MRI marker capsules showing the line of best fit as y = 0.03x ± 0.12. The degree of correlation was assessed using the Spearman's rank correlation coefficient test, and we report a Spearman's r-value of 0.85 (p < 0.0001). (B) Agreement between WGT measurements. Bland-Altman plot showing the average WGT measured using the ROMS and MRI marker capsules on the x-axis, and the difference between the WGT measured using the two methods on the y-axis. This plot shows that there was a mean difference of −0.005 h between test types (middle dotted line), with limits of agreement ranging from 25.68 to −25.69 h (upper and lower dotted lines).

References

    1. Jones J, Boorman J, Cann P, et al. British Society of Gastroenterology guidelines for the management of the irritable bowel syndrome. Gut. 2000;47:1–19.
    1. Drossman DA. The functional gastrointestinal disorders and the Rome II process. Gut. 1999;45:1–5.
    1. Rao SS, Camilleri M, Hasler WL, et al. Evaluation of gastrointestinal transit in clinical practice: position paper of the American and European Neurogastroenterology and Motility Societies. Neurogastroenterol Motil. 2011;23:8–23.
    1. Chang L, Drossman DA. Rome Foundation endpoints and outcomes conference 2009: optimising clinical trials in FGID. J Gastroenterol. 2010;105:722–30.
    1. Metcalf AM, Phillips SF, Zinsmeister AR, MacCarty RL, Beart RW, Wolff BG. Simplified assessment of segmental colonic transit. Gastroenterology. 1987;92:40–7.
    1. Camilleri M, Colemont LJ, Phillips SF, et al. Human gastric-emptying and colonic filling of solids characterized by a new method. Am J Physiol. 1989;257:284–90.
    1. Weitschies W, Blume H, Monnikes H. Magnetic marker monitoring: high resolution real-time tracking of oral solid dosage forms in the gastrointestinal tract. Eur J Pharm Biopharm. 2010;74:93–101.
    1. Camilleri M, Thorne NK, Ringel Y, et al. Wireless pH-motility capsule for colonic transit: prospective comparison with radiopaque markers in chronic constipation. Neurogastroenterol Motil. 2010;22:874–82.
    1. Hahn T, Kozerke S, Schwizer W, Fried M, Boesiger P, Steingoetter A. Visualization and quantification of intestinal transit and motor function by real-time tracking of F-19 labeled capsules in humans. Magnet Reson Med. 2011;66:812–20.
    1. Szarka LA, Camilleri M. Methods for the assessment of small-bowel and colonic transit. Semin Nucl Med. 2012;42:113–23.
    1. Marciani L, Cox EF, Hoad CL, et al. Postprandial changes in small bowel water content in healthy subjects and patients with irritable bowel syndrome. Gastroenterology. 2010;138:469–90.
    1. Hoad CL, Marciani L, Foley S, et al. Non-invasive quantification of small bowel water content by MRI: a validation study. Phys Med Biol. 2007;52:6909–22.
    1. Vassallo M, Camilleri M, Phillips SF, Brown ML, Chapman NJ, Thomforde GM. Transit through the proximal colon influences stool weight in the irritable-bowel-syndrome. Gastroenterology. 1992;102:102–8.
    1. Geypens B, Bennink R, Peeters M, et al. Validation of the lactose-[C-13]ureide breath test for determination of orocecal transit time by scintigraphy. J Nucl Med. 1999;40:1451–5.
    1. Placidi E. Magnetic Resonance Imaging of Colonic Function. Nottingham: The University of Nottingham; 2011.
    1. Eggers H, Brendel B, Duijndam A, Herigault G. Dual-echo Dixon imaging with flexible choice of echo times. Magn Reson Imaging. 2011;65:86–107.
    1. Horikawa Y, Mieno H, Inoue M, Kajiyama G. Gastrointestinal motility in patients with irritable bowel syndrome studied by using radiopaque markers. Scand J Gastroenterol. 1999;34:1190–5.
    1. Krevsky B, Malmud LS, Dercole F, Maurer AH, Fisher RS. Colonic transit scintigraphy - a physiological approach to the quantitative measurement of colonic transit in humans. Gastroenterology. 1986;91:1102–12.
    1. Buhmann S, Kirchhoff C, Ladurner R, Mussack T, Reiser MF, Lienemann A. Assessment of colonic transit time using MRI: a feasibility study. Eur Radiol. 2007;17:669–74.
    1. Deiteren A, Camilleri M, Bharucha AE, et al. Performance characteristics of scintigraphic colon transit measurement in health and irritable bowel syndrome and relationship to bowel functions. Neurogastroenterol Motil. 2010;22:415–23.
    1. Cremonini F, Mullan BP, Camilleri M, Burton DD, Rank MR. Performance characteristics of scintigraphic transit measurements for studies of experimental therapies. Aliment Pharmacol Ther. 2002;16:1781–90.
    1. Davis SS, Hardy JG, Fara JW. Transit of pharmaceutical dosage forms through the small intenstine. Gut. 1986;27:886–92.
    1. Proano M, Camilleri M, Phillips SF, Brown ML, Thomforde GM. Transit of solids through the human colon - regional quantification in the unprepared bowel. Am J Physiol. 1990;258:856–62.
    1. Maqbool S, Parkman HP, Friedenberg FK. Wireless capsule motility: comparison of the SmartPill(A (R)) GI monitoring system with scintigraphy for measuring whole gut transit. Digest Dis Sci. 2009;54:2167–74.
    1. Adkin DA, Davis SS, Sparrow RA, Wilding IR. Colonic transit of different sized tablets in healthy-subjects. J Control Release. 1993;23:147–56.
    1. Malagelada JR, Robertson JS, Brown ML, et al. Intestinal transit of solid and liquid components of a meal in health. Gastroenterology. 1984;87:1255–63.
    1. Hardy JG, Wilson CG, Wood E. Drug delivery to the proximal colon. J Pharm Pharmacol. 1985;37:874–7.
    1. Rao SS, Kuo B, McCallum RW, et al. Investigation of colonic and whole-gut transit with wireless motility capsule and radiopaque markers in constipation. Clin Gastroenterol Hepatol. 2009;7:537–44.
    1. Meyer J, Dressman J, Fink A, Amidon G. Effect of size and density on canine gastric emptying of nondigestible solids. Gastroenterology. 1985;89:805–13.
    1. Devereux JE, Newton JM, Short MB. The influence of density on the gastrointestinal transit of pellets. J Pharm Pharmacol. 1990;42:500–1.
    1. Clarke GM, Newton JM, Short MD. Gastrointestinal transit of pellets of differing size and density. Int J Pharmaceut. 1993;100:81–92.
    1. Boulby P, Gowland P, Adams V, Spiller RC. Use of echo planar imaging to demonstrate the effect of posture on the intragastric distribution and emptying of an oil/water meal. Neurogastroenterol Motil. 1997;9:41–7.
    1. Degen LP, Phillips SF. Variability of gastrointestinal transit in healthy women and men. Gut. 1996;39:299–305.
    1. Miller MA, Parkman HP, Urbain JLC, et al. Comparison of scintigraphy and lactulose breath hydrogen test for assessment of orocecal transit - Lactulose accelerates small bowel transit. Digest Dis Sci. 1997;42:10–8.
    1. Sarosiek I, Selover KH, Katz LA, et al. The assessment of regional gut transit times in healthy controls and patients with gastroparesis using wireless motility technology. Aliment Pharm Therap. 2010;31:313–22.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj