MR fluoroscopy for gastrointestinal malrotation in unsedated infants

Introduction Gut malrotation is a congenital disorder of abnormal intestinal rotation and fixation, which predisposes to life-threatening mid-gut volvulus. The condition is frequently suspected in neonates with recurrent vomiting and the current diagnostic technique is an upper GI X-ray fluoroscopy contrast study. This is not easy to perform and may give equivocal results [1-3]. It also carries a significant radiation burden, particularly as the majority of patients referred and assessed in this way do not have an abnormality. Occasionally an additional X-ray study, a contrast enema, may be required to identify the position of the caecum, or an ultrasound examination to define the orientation of the superior mesenteric vessels, which may be abnormal in volvulus [4, 5]. No single imaging technique can currently examine all of these structures, but real-time MR imaging has the potential to be an alternative single examination. The aim of this study was to evaluate the feasibility of interactive MR fluoroscopy for defining the gastro-intestinal tract anatomy in un-sedated neonates and children with suspected malrotation.