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Proceedings of the 2005 IEEE

Engineering in Medicine and Biology 27th Annual Conference


Shanghai, China, September 1-4, 2005

Preliminary Results from Clinical Application of a Natural Oral


Contrast Agent in Magnetic Resonance Imaging (MRI) of the
Gastrointestinal (GI) System
T. Arruda-Sanchez; L.E.A. Troncon; R. Brandt-Oliveira; J. Elias Jr., L.A. Colnago,

D.B. Arajo, D.B. and Baffa O.

University of So Paulo Ribeiro Preto SP - Brazil

tolerated but usually fails in opacifying the entire




Abstract A natural magnetic resonance imaging (MRI)


contrast based on the pulp of a fruit Euterpe Olercea, bowel. It also needs to be buffered when used orally
popularly known as Aa, was investigated. T1 and T2 since this chelate is not very stable at low pH found in
contrasted images shown the effects of the contrast agent the stomach, what can alter the gastric function.
increasing the ability to visualize the contour of segments of
the gastrointestinal tract.
We herein present the preliminary implementation of a
natural oral contrast agent, Euterpe Olercea
INTRODUCTION (popularly named Aa), as a possible alternative
contrast agent for MRI of the gastrointestinal (GI) tract.

U sing contrast agents is a common practice in The pulp of Aa, a fruit from the Amazon area, can be
medical imaging protocols, as is the case of widely found in tropical regions. Considering the
Magnetic Resonance Imaging. The evaluation of GI biphasic contrast revealed in the preliminary study [4],
tract by means of MRI has a close relation to this natural oral contrast agent could be clinically used,
availability of oral contrast agents. Oral contrasts are primarily to assist for a better contrast in images from
attractive to MRI if they have good digestive stomach and from a rotine examination of the
acceptance, uniform distribution in the bowel lumen, biliopancreatic tract, in Magnetic Resonance
unchanged contrast effect when diluted throughout the Cholangiopancreatography (MRCP).
gastrointestinal tract (GI), no toxicity, no peristalsis During MRCP, difficulties in the assessment of the
stimulus, and acceptable cost. Although some of them gallbladder, cystic duct, common bile duct (CBD), and
are commercially available, they are still not used pancreatic duct may be encountered because these
routinely in most clinical centers nowadays, due to structures are frequently masked by the overlap of the
many factors, such as possible side effects. Oral signal hyper-intensity from the surrounding tissues
contrast agents are usually classified by their increase contend [5]. We investigate the feasibility of using this
(positive agents) or decrease (negative agents) of the natural solution as a gastrointestinal oral negative
magnetic resonance imaging signal within the bowel contrast agent to null the bowel signal during MRCP.
[1].
GI agents change intra-luminal signal either by a METHODOLOGY
paramagnetic shortening of T1 or T2 of nearby tissues All images were acquired using a Siemens 1.5 T
or by having intrinsically short relaxation times [1,2,3]. Scanner (Magneton Vision). A body array coil was
Actually, many contrast solutions would be capable of used to generate T1-weighted images (TR/TE =
changing signal intensity, typically based on heavy 177.8/4.1 ms, FOV 350 mm, 256 x 256, 6 mm slice
metal ions, as of Gadolinium (III), Manganese (II), thickness) and T2-weighted images (TR/TE = 4400/64
Manganese (III), Iron (III), and copper (II) [4]. However, ms, FOV = 350 mm, 256 x 256, 6 mm slice thickness)
they have generally intrinsic side effects when used at a standard turbo spin-echo (TSE) sequence.
orally [0]. Ferric iron, for example, can provoke teeth We studied 10 non-symptomatic subjects, with 12
staining, gastric irritation, nausea, diarrhea, and hours of fasting. Ten axial slices centered at the
constipation. Mannitol may cause nausea, vomiting, stomach region were acquired, under three distinct
and diarrhea [2]. Gd-DTPA without Mannitol is well experimental conditions: first in the fasting state with
an empty stomach (baseline), followed by the ingestion
Manuscript received March 10, 2005. This work was supported in part of water and finally by the ingestion of Aa. As to
by the CNPq and CAPES. T. Arruda-Sanchez DFM FFCLRP Av implement the contrast agent in the clinical
Bandeirantes, 3900 14.040-901 Ribeirao Preto SP Brazul environment, these subjects more 35 patients were
tiago@biomag.usp.br.

0-7803-8740-6/05/$20.00 2005 IEEE. 1382


submitted to the same hospital protocol for MRCP that
is based in the same T2-weighted standard TSE
sequence parameters, which was approved by the
institutional ethics committee.

RESULTS

T1 and T2 weighted images from the stomach of a


fasting healthy volunteer are presented in figure 1. In
figure 1a and figure 1d we observe an empty stomach.
Subsequently, the subject ingested 200 ml of water,
and another set of T1 (Fig. 1b) and T2 (Fig. 1e) was
acquired. The expansion of the gastric volume is
clearly observed and two phases can be identified on
the images: a small dark region corresponding to air
and a larger area of slight contrast increase
corresponding to water. Finally, 200 ml of the Aa pulp
was ingested by the subject and the last series of MR
images were obtained. Figure 1c shows one T1-
weighted image. The increase of contrast due to the
presence of Aa is conspicuous. Three well defined
regions can be identified: air, water and Aa. Also, the
T2 sequence presents a high contrast in the gastric
lumen due to low signal intensity from Aai (Fig. 1f).
We looked for intrinsic properties that could be
responsible for the T1 signal enhancement and T2
opacification. Atomic Absorption spectra revealed the
presence of Fe, Mn and Cu ions in Aai. Although Figure 2. T2-weighed images from 2 patients (a)
there is no information yet about how these ions are and (b) during fasting (left) and after Acai
complexed with the organic matrix, their presence is ingestion (right). Overlap is eliminated (pentagram)
probably the main cause for the image contrast which allows gallbladder and biliary ducts (large
changes. and small arrows ) to be more visible after Aai
ingestion.

We can see the image clearance (Fig. 2) due to the


reduced signal from the Aa pulp present in stomach
and bowel loops.

DISCUSSION AND CONCLUSION

The contrast enhancement due to Aa in T1-weighed


images is evident, producing a better definition of the
gastric lumen. These results open a wide perspective
Figure 1. T1 and T2 weighed images in an axial plane. T1 for the clinical use of such contrast agent, as an
images are on the top line, while T2 are on the bottom. (a) alternative oral contrast for imaging the intestinal
T1 image of an empty stomach. (b) T1 of the same volunteer lumen, functional evaluation of dyspepsia and other
with air and 200ml of water. (c) T1 image with air, 200ml of pathological states.
water and 200ml of Aai. (d) T2 image of an empty The contrast enhancement due to Aa in T1-weighted
stomach. (e) T2 image of air and 200 ml of water. (f) T2 images is evident (Fig. 1c), producing a better
image of air, 200ml of water and 200ml of Aai. definition of the gastric lumen. Thus, these results
open a wide perspective for Aa as an alternative oral
Figure 2 shows T2 images, in the coronal plane, contrast agent that can be employed for imaging the
from 2 patients submitted to MRCP. The MRI signal intestinal lumen, functional evaluation of dyspepsia, in
from bowel loops, superposed to the common bile addition to the applications of the gastrointestinal
duct, is subtracted, allowing the complete observation motility [6,7].
of the gall bladder after the ingestion of Aa.
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Aa has great advantages since is a natural and
palatable food with no expected side effects or adverse
reactions. In every patient studied thus fat, only one
had nausea after ingesting the Acai pulp. As for
MRCP, the results indicate a possible application from
the signal reduction of gastric acid and intestinal loops.
The Acai pulp may improve the visualization of
pancreatic and biliary ducts.

ACKNOWLEDGMENT

The authors thanks the technical support of Loureno


Rocha, Carlos Brunello, Matheus Guerreiro, Reginaldo
Ferreira Chagas, Luciano Kazuo Akita and the MRI
service of Hospital das Clinicas, Faculdade de
Medicina de Ribeiro Preto to make available its
facilities.

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