Peter M. Ghobrial MD, Abstract Co-Author: Nothing to Disclose

Flavius F. Guglielmo MD, Presenter: Nothing to Disclose

Donald G. Mitchell MD, Abstract Co-Author: Consultant, CMC Contrast AB

Ilana Neuberger MD, Abstract Co-Author: Nothing to Disclose

Laurence Parker PhD, Abstract Co-Author: Nothing to Disclose

Christopher Geordie Roth MD, Abstract Co-Author: Author, Reed Elsevier

Sandeep Prakash Deshmukh MD, Abstract Co-Author: Nothing to Disclose

Patrick L. O'Kane MD, Abstract Co-Author: Research Consultant, NPS Pharmaceuticals Research Consultant, Johnson & Johnson

Allison Borowski MD, Abstract Co-Author: Nothing to Disclose

To use a cine MR enterography (cine-MRE) pulse sequence to assess the effectiveness of a sublingual (SL) antiperistaltic agent, hyoscyamine sulfate. 

IRB approval was granted with an exemption for informed consent in this HIPAA compliant retrospective single-institution study. Of the 288 MR enterography exams performed between October 1, 2007 and January 15, 2011, 92 using SL hyoscyamine sulfate for antiperistalsis were included for review, each with cine MRE pre and post medication. These 184 cine MRE sequences were randomized, blinded for treatment, and independently reviewed by five attending abdominal radiologists, who rated the degree of bowel motility of each cine MRE sequence on a five point scale. Pre- and post-medication mean peristalsis ratings, standard deviation, mean difference, and treatment effect sizes were calculated. A repeated measures analysis of variance (ANOVA) test was performed, using a significance threshold of p=0.05. 

Mean peristalsis ratings ranged from 2.63 to 3.34 before, to 2.36 to 3.03 after medication administration. The mean differences ranged from 0.22 to 0.46, which are treatment effect sizes of 0.10 to 0.18. The decrease in peristalsis observed by the five reviewing radiologists after SL hyoscyamine sulfate administration was significant (df 1/182, f=7.35, p<.01). 

While cine MRE sequences show decreased bowel peristalsis after use of SL hyoscyamine sulfate, the small size of the observed treatment effect is likely insufficient to justify its use for MR enterography. 

While it is possible to detect and quantify decreased bowel peristalsis caused by a sublingal anti-spasmodic agent during cine MRE, the decrease is likely too small to be of clinical significance.

Ghobrial, P, Guglielmo, F, Mitchell, D, Neuberger, I, Parker, L, Roth, C, Deshmukh, S, O'Kane, P, Borowski, A, Cine MR Enterography Grading of Small Bowel Peristalsis: Evaluation of the Antiperistaltic Effectiveness of Sublingual Hyoscyamine Sulfate.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13016243.html