Background: The purpose of this study was to assess the feasibility and usefulness of a new magnetic resonance (MR) colonography technique for the detection of colorectal pathology in comparison with conventional colonoscopy as the standard of reference. Patients and methods: A total of 122 subjects with suspected colorectal disease underwent ''dark lumen'' MR colonography. A contrast enhanced T1w three dimensional VIBE sequence was collected after rectal administration of water. The presence of colorectal masses and inflammatory lesions were documented. Results were compared with those of a subsequently performed colonoscopy. Results: MR colonography was found to be accurate regarding detection of clinically relevant colonic lesions exceeding 5 mm in size, with sensitivity and specificity values of 93%/100%. Conclusion: Dark lumen MR colonography can be considered as a promising alternative method for the detection of colorectal disease. In addition, it allows assessment of extraluminal organs.

MR elastography (MRE) has been shown to be capable of non-invasively measuring tissue elasticity even in deep-lying regions. Although limited studies have already been published examining in vivo muscle elasticity, it is still not clear over what range the in vivo elasticity values vary. The present study intends to produce further information by examining four different skeletal muscles in a group of 12 healthy volunteers in the age range of 27-38 years. The examinations were performed in the biceps brachii, the flexor digitorum profundus, the soleus and the gastrocnemius. The average shear modulus was determined to be 17.9 (+/- 5.5), 8.7 (+/- 2.8), 12.5 (+/- 7.3) and 9.9 (+/- 6.8) kPa for each muscle, respectively. To ascertain the reproducibility of the examination, the stiffness measurements in two volunteers were repeated seven times for the biceps brachii. These examinations yielded a mean shear modulus of 11.3 +/-.7 and 13.3 +/- 4.7 kPa for the two subjects. For elasticity reconstruction, an automated reconstruction algorithm is introduced which eliminates variation due to subjective manual image analysis. This study yields new information regarding the expected variation in muscle elasticity in a healthy population, and also reveals the expected variability of the MRE technique in skeletal muscle.

The data indicate that sufficient contrast consumption and optimal timing of data acquisition are essential to distention of the small bowel. Oral contrast agent protocols should be adapted to the bowel region in question.

The presented data point toward an increased use of MRI for screening in the future, but to date screening MRI should not be performed outside a research setting because the cost-benefit relation is unclear.

Introduction: The purpose of this study was to assess the diagnostic accuracy of magnetic resonance colonography (MRC) for its ability to detect and quantify inflammatory bowel disease (IBD) affecting the colon. Endoscopically obtained histopathology specimens were used as the standard of reference. Materials and methods: Fifteen normal subjects and 23 patients with suspected IBD of the large bowel underwent MRC. Three dimensional T1 weighted data sets were collected following rectal administration of water prior to and 75 seconds after intravenous administration of paramagnetic contrast (gadolinium-BOPTA). The presence of inflammatory changes in patients was documented based on bowel wall contrast enhancement, bowel wall thickness, presence of perifocal lymph nodes, and loss of haustral folds. All four criteria were quantified relative to data obtained from normal subjects and summarised in a single score. This MRC based score was compared with histopathological data based on conventional endoscopic findings. Results: MRC correctly identified 68 of 73 segments found to reveal IBD changes by histopathology. All severely inflamed segments were correctly identified as such and there were no false positive findings. Based on the proposed composite score, MRC detected and characterised clinically relevant IBD of the large bowel with sensitivity and specificity values of 87% and 100%, respectively, for all investigated colonic segments. Conclusion: MRC may be considered a promising alternative to endoscopic biopsy in monitoring IBD activity or assessing therapeutic effectiveness.

Background: The aim of this study was to evaluate whether patients with increased or decreased gastric motility can be differentiated from healthy volunteers by means of real time magnetic resonance imaging (MRI). Patients and methods: Ten healthy volunteers, 10 patients with gastroparesis, and 10 patients with functional pylorospasm/peptic pyloric stenosis underwent real time MRI. All patients were examined on two separate days; once prior to therapy and once after adequate therapy. Antral motility was quantified by calculating the gastric motility index. Results: Patients with gastroparesis showed a lower motility index compared with the reference volunteer group while the mean motility index of the patient group with pylorospasm was more than three times higher than that of the reference value of the volunteer group. However, the gastric motility index in the patient group with gastroparesis increased, and in the group with functional pylorospasm/peptic pyloric stenosis it decreased significantly after therapy. Conclusion: Real time MRI is a reliable tool for assessment of gastric motion. Furthermore, differences in gastric motility index in patients with increased or decreased gastric motility could be evaluated and quantified. Due to the non-invasive character of MRI, this imaging modality may be an attractive alternative to conventional invasive diagnostic tools for gastric motility disorders and therapeutic monitoring.

Objectives: Sleep apnoea has been consistently reported to occur in acromegaly. Both obstructive apnoeas, in which apnoeas are due to intermittent obstruction of the upper airways, as well as central apnoeas are known to occur. Because the relationship between disease activity and severity of sleep apnoea is currently unclear, we have performed a prospective study to address this issue. Design and methods: In 14 newly diagnosed patients with active acromegaly (eight females and six males; mean age 57^4 years; IGF-I 583^48 mg/l; GH 13.5^7.0 mg/l (means^S.E.M.)), tongue volume and signal intensity of the tongue were examined by magnetic resonance imaging and sleep apnoea was characterised by polysomnography before and after 6 months of treatment with octreotide acetate (Sandostatin LAR 10 -30 mg every 4 weeks i.m.). Results: The initial tongue volume was significantly higher in patients with acromegaly (151^9 ml; females 133^10 ml; males 172^10 ml) in comparison with the body mass index (BMI)-and agematched healthy control group (97^5 ml, P , 0.001; females 75^1 ml, P , 0.001; males 120^3 ml, P , 0.003). After treatment with octreotide, IGF-I was normalised within the ageadjusted normal range in 50% of the patients. In these patients, tongue volume significantly decreased (120^14 ml, P , 0.05) in comparison with the persistent uncontrolled group of acromegalics (137^10 ml, P ¼ not significant). Overall, tongue volume (128^8 ml, P , 0.05) and the signal intensity ratio of the tongue decreased significantly after treatment with octreotide acetate (120^3 vs 105^3, P ¼ 0.003). The BMI-adjusted tongue volume correlated with IGF-I levels (r ¼ 0.60, P , 0.002) and the disease duration (r ¼ 0.71, P ¼ 0.006). At baseline, 50% had obstructive sleep apnoea with a mean respiratory disturbance index (RDI) of . 20/h (range 5.1-91.5) and no patient had central sleep apnoea. After 6 months of octreotide treatment, there was a 28^10% decrease in RDI. However, RDI did not correlate with IGF-I or GH levels, but correlated positively with BMI (r ¼ 0.58, P ¼ 0.001) and age (r ¼ 0.46, P ¼ 0.02). Conclusions: Obstructive sleep apnoea but not central sleep apnoea frequently occurs in patients with active acromegaly. Successful treatment with octreotide can decrease tongue volume, which may have benefits for coexisting sleep-disordered breathing.European Journal of Endocrinology 151 309-315

MRI of the small bowel is a new method for the assessment of inflammatory bowel diseases. However, inflammatory bowel disease can affect both the small and large bowel. Therefore, our goal was to assess the feasibility of displaying the small bowel and colon simultaneously by MR imaging. Eighteen patients with inflammatory bowel disease were studied. For small bowel distension, patients ingested a solution containing mannitol and locust bean gum. Furthermore, the colon was rectally filled with water. MR examinations were performed on a 1.5-T system. Before and after intravenous gadolinium administration, a T1w data set was collected. All patients underwent conventional colonoscopy as a standard of reference. The oral ingestion and the rectal application of water allowed an assessment of the small bowel and colon in all patients. By means of MRI (endoscopy), 19 (13) inflamed bowel segments in the colon and terminal ileum were detected. Furthermore, eight additional inflammatory lesions in the jejunum and proximal ileum that had not been endoscopically accessible were found by MRI. The simultaneous display of the small and large bowel by MRI is feasible. Major advantages of the proposed MR concept are related to its non-invasive character as well as to the potential to visualize parts of the small bowel that cannot be reached by endoscopy.