The efficacy of pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography

Abstract

Background: During magnetic resonance cholangiopancreatography (MRCP), the pancreatobiliary ducts can be obscured by the high-intensity signal from the stomach and duodenum. Pineapple juice may be an alternative to commercially available negative contrast agents, but has not been evaluated locally.Objectives: To evaluate the efficacy of a local, off-the-shelf pineapple juice preparation as a negative oral contrast agent for MRCP.Method: An observational, analytical study was conducted during January–December 2017. A 1.5 Tesla MRCP sequence was performed immediately before and after ingestion of 250 mL of a local, commercially-available pineapple juice preparation. Image evaluation was performed by two radiologists with independent, blind assessment of gastric/duodenal signal intensity and biliary /pancreatic duct visibility, before and after pineapple juice.Results: Fifty adult patients (F = 44, 88%) with median age 44 years (IQR: 34.75, 57) were included. After pineapple juice administration, there was significant measured (1661.51 vs. 1409.94, p 0.01) and perceived (2.16 vs. 2.72, p 0.01) duodenal signal reduction but no significant change in measured (1081.17 vs. 1044.38, p = 0.34) or perceived (2.73 vs. 2.84, p = 0.14) gastric signal intensity. Visibility of the common bile duct was significantly improved (3.67 vs. 3.86, p 0.01), whilst that of the main pancreatic duct showed no significant change (2.92 vs. 2.86, p = 0.44).Conclusion: The local pineapple juice preparation used in this study is an effective, affordable and natural negative oral contrast agent for enhancement of MRCP images, and specifically improves visualisation of the common bile duct.

Combined Use of Negative Oral Contrast and Ranitidine for Magnetic Resonance Cholangiopancreatography: A Randomized Controlled Trial

“…However, pineapple juice did not decrease the signal intensity in the stomach. 6 In our study, we observed that the group that received both ranitidine and hematinic syrup had decreased signal intensities in both duodenum and stomach. Govindarajan et al used date syrup as negative oral contrast and compared the image quality of pre- and post-oral contrast images of the same patients.…”

“…Another reason could be that we relied more on 3D sequence to score the structure visualization score, as it is superior in depicting the individual parts of pancreaticobiliary ductal system, while two-dimensional sequences and MIP images were used for scoring the image quality in majority of the studies reported in literature. 2 5 6 7 12 13 14 15 16…”

“…The authors believed that the concentration of the manganese in the pineapple juice in general could vary from 9.3 to 12.7 mg/L; however, they did not mention the exact concentration of that particular brand of pineapple juice that they used for the study. 6 In our region, commercially prepared pure pineapple or blue berry juices are not readily or widely available and the manufacturers do not provide the manganese concentration.…”

“…Another reason could be that we relied more on 3D sequence to score the structure visualization score, as it is superior in depicting the individual parts of pancreaticobiliary ductal system, while two-dimensional sequences and MIP images were used for scoring the image quality in majority of the studies reported in literature. 2,[5][6][7][12][13][14][15][16] One of the main limitations of our study was that the assessment of image quality was subjective and no quantitative method was used; however, the interobserver agreement between the readers was acceptable. Another drawback was that our study population included patients with different pathologies in various age group as healthy volunteers in similar age group or patients with same pathology would be preferable in ideal situation.…”

Oral effervescent agent improving magnetic resonance cholangiopancreatography

“…Because of the proximity of the stomach and duodenum to the pancreatobiliary tree and the projectional nature of these images, 2D MRCP sequence has the potential technical limitation that the hyperintense intraluminal fluid signal within the adjacent stomach or duodenum may superimpose upon the pancreatobiliary tree, hindering comprehensive evaluation of this system (7)(8)(9)(10)(11). To overcome this drawback, some kinds of juice or syrup (including acai, blueberry, pineapple juice, and data syrup) has been proposed as the oral negative contrast agents to effectively decrease the high signal of the gastrointestinal tract (7,8,(12)(13)(14)(15) and improve MRCP image quality, but it is unfortunately not easy to get in such large volumes for clinical practice. Recently, it has been shown that oral administration of the effervescent agent can improve MRCP images, both qualitatively and quantitatively, for the purpose of biliary anatomy evaluation in the living liver donors (1).…”