Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2020; 26(36): 5484-5497
Published online Sep 28, 2020. doi: 10.3748/wjg.v26.i36.5484
Motility index measured by magnetic resonance enterography is associated with sex and mural thickness
Sven Månsson, Olle Ekberg, Bodil Ohlsson
Sven Månsson, Medical Radiation Physics, Department of Translational Medicine, Lund University, Skåne University Hospital Malmö, Malmö 20502, Sweden
Olle Ekberg, Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö 20502, Sweden
Bodil Ohlsson, Department of Internal Medicine, Skåne University Hospital, Lund University, Malmö S-205 02, Sweden
Author contributions: Ekberg O, Månsson S and Ohlsson B designed and performed the research study; Ekberg O, Månsson S and Ohlsson B analyzed the data; Ohlsson B wrote the initial draft of the paper; all authors contributed to the intellectual process during the writing and finalization of the manuscript.
Supported by the Development Foundation of Region Skåne, No. REGSKANE-619091; the Foundation of Skåne University Hospital, No. 2017-008; and the Dir Albert Påhlsson’s Foundation, No. 2019.
Institutional review board statement: This study was performed in accordance with the Helsinki Declaration and approved by the Ethics Review Board at Lund University (No 2016/330, date of approval 4 August 2016). All patients and healthy volunteers gave their written informed consent before inclusion.
Conflict-of-interest statement: There are no conflicts of interest for any of the authors.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at email adress bodil.ohlsson@med.lu.se.
STROBE statement: The guidelines of the STROBE Statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bodil Ohlsson, MD, PhD, Professor, Department of Internal Medicine, Skåne University Hospital, Lund University, Jan Waldenströms Street 15, Malmö S-205 02, Sweden. bodil.ohlsson@med.lu.se
Received: June 12, 2020
Peer-review started: June 12, 2020
First decision: July 25, 2020
Revised: July 27, 2020
Accepted: September 4, 2020
Article in press: September 4, 2020
Published online: September 28, 2020
Processing time: 103 Days and 19 Hours
Abstract
BACKGROUND

Recently, a technique has been developed to use magnetic resonance enterography (MRE) for the evaluation of small bowel motility. The hypothesis was that assessment of the motility index (MI) should reflect differences in motility between clinical conditions.

AIM

To aim of the present observational, cross-sectional study was to evaluate the use of the MI in daily clinical practice.

METHODS

All consecutive patients aged 18-70 years who were referred for MRE at the Department of Radiology during a 2-year period were asked to participate. Healthy volunteers were included as controls. MRE was prepared and conducted in accordance with clinical routines. On the day of examination, all the participants had to complete the visual analog scale for irritable bowel syndrome (IBS) and IBS-symptom severity scale. Maps of MI were calculated from dynamic MR images. ANOVA was used to evaluate differences in MI between groups, classified as healthy, Crohn’s disease, ulcerative colitis, IBS, other assorted disorders and dysmotility. Logistic and linear regression were applied to the MI values. All medical records were scrutinized for medical history.

RESULTS

In all, 224 examinations were included (inclusion prevalence 76.3%), with 22 controls and 202 patients. There was a significant difference in the MI of the jejunum (P = 0.021) and terminal ileum (P = 0.007) between the different groups. The MI was inversely associated with the mural thickness of the terminal ileum in men (P < 0.001) and women (P = 0.063) after adjustments, and tended to be lower in men than in women (P = 0.056). Subjectively observed reduction of motility on MRI was accomplished by reduced MI of terminal ileum in men (P < 0.001) and women (P = 0.030). In women, diarrhea was inversely associated with the MI of the jejunum (P = 0.029), and constipation was positively associated with the MI of the terminal ileum (P = 0.039).

CONCLUSION

Although MIs differ across diseases, a lower MI of the terminal ileum is mainly associated with male sex and an increased mural thickness. Symptoms are weakly associated with the MI.

Keywords: Dysmotility; Gastrointestinal symptoms; Magnetic resonance enterography; Motility index; Mural thickness; Small bowel

Core Tip: Motility index (MI) of the terminal ileum measured by magnetic resonance enterography (MRE) was inversely associated with mural thickness, especially in men. The tendency of lower MI in men than in women, could possibly be explained by higher weight in men. In women, diarrhea was inversely associated with MI of jejunum, and constipation was positively associated with MI of terminal ileum. There were differences in MI of jejunum and terminal ileum between healthy controls and other assorted diseases. MIs in the jejunum and ileum revealed few findings. It seems essential to develop additional techniques to identify true motility patterns according to MRE.