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Marshfield Clinic and Marshfield Clinic Research Foundation Marshfield, WI 54449
We read the article by Lauenstein et al. [1] with appreciation. We find it interesting that MRI can be used for gastric emptying. Performing gastric emptying studies with the use of MRI is an accomplishment, but MRI may be better used for more important studies. Nuclear medicine can perform the gastric emptying studies quickly without a long scheduling delay.
High-calorie vanilla ice cream is tasty (much unlike the liver pâté I formerly used) and is a generally acceptable meal for most people except those with lactase deficiency. We did find another reference describing ice cream being used for MRI, but it was in a different type of study [2]. However, no evidence or published reference shows that gadolinium does not disassociate from the ice cream once it is in the stomach.
Most people who use labeled scrambled eggs use sulfur colloid [3]. Other labeled meals that have been successfully used include water, cooked egg, chicken liver [4], oatmeal [5], and chicken liver mixed with ground beef and water [6, 7].
References
University Hospital Essen Essen 45122, Germany
I thank Drs. Spieth and Gauger for their comments on our article about MRI of gastric emptying [1]. Certainly, MRI is not a completely new technique for the assessment of gastrointestinal motility. In fact, it was described for the first time in 1989 by Stehling et al. [2] in conjunction with echoplanar MRI techniques. Schwizer et al. [3] investigated the application of T1-weighted sequences and gadolinium-marked foodstuffs in 1992. In spite of numerous other studies underlining the potential of MRI for the evaluation of gastric motility and emptying, this technique has not really broken into the daily clinical routine, perhaps because competitive scintigraphic studies can easily be performed without time-consuming preparation and data acquisition [4]. However, one should not forget certain advantages of MRI over scintigraphy, including the higher spatial and temporal resolution. Hence, the assessment of concomitant inflammatory or neoplastic disease is possible—not only for the stomach, but also for all other anatomic structures of the upper abdomen.
Another interesting aspect is related to the question of whether gadolinium-spiked meals might be toxic. To our knowledge, the oral administration of paramagnetic MRI contrast agents has been shown to be safe. In vitro and in vivo experiments failed to show any absorption through mucosal surfaces, and gadolinium chelates were stable over a wide range of pH values [5]. I agree that labeled ice cream or vanilla cream might be considered more tasty by most patients and their use might enhance patient acceptance.
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