MRI to Assess Fibrosis in Eosinophilic Esophagitis Patients

MRI will be performed on a 1.5T magnet. Patients will be scanned in an oblique prone position
similar to how esophageal distention is assessed at barium fluoroscopy. The following
sequences and rationale will be used for the examination:

A sagittal 50mm thick multiphase FIESTA and multiphase SSFSE will be performed while the
patient drinks water. The temporal resolution of the images will be approximately 1 image
every 1.5-2 seconds. The images will be used to assess the lumen caliber and the wall
thickness during maximal distension as pseudothickening can occur with decreased luminal
distension.

Sagittal SSFSE with fat suppression, sagittal FRFSE T2-weighted images with fat suppression,
axial DWI and sagittal DWI will be performed to asses for edema and inflammation within the
esophageal wall.

axial FS SSFSE or FIESTA will be performed and targeted to the region of stricturing.

Dynamic sagittal imaging will be performed following IV contrast to assess for mural
hyperenhancement which can be seen mural inflammation and delayed enhancement which can be
seen in fibrosis. Sequential acquisitions will be performed beginning at 40 seconds following
IV contrast injection. Delayed acquisitions will be performed at 5 min and 7 min. Patients
will be asked to perform swallowing during the image acquisition to reduce the potential for
pseudoenhancement secondary to under distension.

Inclusion criteria:

- Adults ages 18-70 years of age

- Diagnosis of EoE, i.e. symptoms of esophageal dysfunction with histologic finding of
15 or more eosinophils per high power field on esophageal biopsy despite 8 weeks of
high dose proton pump inhibitor therapy.

- All Subjects diagnosed with Eosinophilic Esophagitis pre and pose therapy

Exclusion criteria:

- Clinical evidence of infectious process potentially contributing to dysphagia (e.g.
candidiasis, CMV, herpes)

- Other cause of dysphagia identified at endoscopy or esophagram (e.g. reflux
esophagitis, stricture, web, ring, achalasia, esophageal neoplasm)

- Esophageal minimal diameter < 13 mm on structured barium esophagram

- Inability to read due to: Blindness, cognitive dysfunction, or English language
illiteracy

- Pregnant women

- Presence of body metallic fragments or devices that prohibit use of MRI

- History of renal disease

- eGRF <30