Ultrafast MRI Imaging to Exclude Constipation
Condition: Constipation
MeSH terms: Constipation
Study type: Interventional

Summary: 
      In haematological malignancy and in immunocompromised patients, constipation is a common
      symptom caused by a number of factors during treatment. In current clinical practice, an
      abdominal radiograph is the first imaging investigation for constipation and non specific
      abdominal pain to support or exclude the clinical suspicion. Children are more sensitive to
      radiation induced adverse effects especially in the thyroid gland and bone marrow.
      Immunocompromised patients are at risk of developing a second malignant neoplasm. MRI is an
      alternative imaging modality without ionizing radiation. Imaging the peritoneal cavity on
      abdominal MRI has always been challenging primarily because of bowel motion and a long
      acquisition time for standard T1 and T2 weighted sequences. Recent development of an
      ultrafast 2 dimensional FIESTA sequence developed by GE (General Electric) Healthcare based
      on the balanced steady state free precession (b-SSFP) pulse sequence has several advantages:
      motion insensitivity ( does not interfere with peristalsis), sharp edge definition and higher
      contrast when compared with the standard SSFSE pulse sequence. FIESTA is well suited for
      abdominal imaging as it produces motion- free images, allowing clear delineation of
      intra-peritoneal and retroperitoneal anatomy and is capable of depicting the vascular anatomy
      and lymph-adenopathy.There is a wide spectrum of diseases which could cause abdominal pain in
      our study group with constipation being the most common cause but MRI could potentially
      detect more serious bowel-related chemotherapy induced complications such as typhlitis,
      pneumatosis coli, veno-occlusive disease, pancreatitis and intra abdominal abscess, which
      would not be apparent on abdominal radiograph.
    

Detailed description: 
      In haematological malignancy and in immunocompromised patients, constipation is a common
      symptom caused by a number of factors during treatment. Chemotherapy and certain analgesic
      medications are major contributory factors in addition to inadequate fluid intake and reduced
      mobility during treatment. In current practice, an abdominal radiograph is the first imaging
      investigation for constipation and non specific abdominal pain to support or exclude the
      clinical suspicion of constipation. However, there is a skin entrance dose of 1.5 msv from
      plain film with radiation exposure to gonads. Children are more sensitive to radiation
      induced adverse effects especially the thyroid gland and bone marrow. Immunocompromised
      patients are also at risk of developing a second malignant neoplasm. Ultrasound is proven to
      detect faecal loading in the rectum without ionizing radiation but it is difficult to assess
      the entire length of colon and it largely depends on the operator's experience. MRI is an
      alternative imaging modality without ionizing radiation. Imaging the peritoneal cavity on
      abdominal MRI has traditionally been challenging primarily because of bowel motion and long
      acquisition time for standard T1 and T2 weighted sequences. The recent development of an
      ultrafast 2 dimensional FIESTA sequence by GE Healthcare based on the balanced steady state
      free precession (b-SSFP) pulse sequence has several advantages, including motion
      insensitivity (does not interfere with peristalsis), sharp edge definition and higher
      contrast when compared with the standard SSFSE pulse sequence. FIESTA images allow clear
      delineation of intra-peritoneal and retroperitoneal anatomy and are capable of depicting the
      vascular anatomy and lymph-adenopathy. There is a wide spectrum of diseases which could cause
      abdominal pain in our study group with constipation being the most common cause but MRI could
      potentially detect more serious bowel related chemotherapy induced complications such as
      typhlitis, pneumatosis coli, veno-occlusive disease, pancreatitis and intra abdominal
      abscess, which would not be apparent on abdominal radiograph.
    

Intervention name(s): MRI
Intervention type(s): Device
Intervention description(s): Ultrafast MRI to assess constipation
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment