Subscribe to RSS
![](/products/assets/desktop/img/oa-logo.png)
DOI: 10.1055/s-0042-1750138
Combined Use of Negative Oral Contrast and Ranitidine for Magnetic Resonance Cholangiopancreatography: A Randomized Controlled Trial
![](https://www.thieme-connect.de/media/10.1055-s-00043197/202301/lookinside/thumbnails/10-1055-s-0042-1750138_22170409-1.jpg)
Abstract
Objective Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive imaging modality to study pancreaticobiliary tree. The primary aim of this study was to compare the image quality of MRCP obtained with the use of ferric ammonium chloride (negative oral contrast) with that of combined use of ferric ammonium chloride and ranitidine (administered orally). Secondary aim was to determine the interobserver agreement between the assessing radiologists.
Materials and Methods The study was a single-center randomized-controlled trial. The patients were randomized into two groups. One group received ranitidine orally and ferric ammonium chloride (Dexorange) and the other group received only the ferric ammonium chloride. The images were qualitatively analyzed independently by the two blinded radiologists. Two scoring systems were used for grading the diagnostic quality of the images: the gastrointestinal tract signal intensity score (range: 1–4) and the structure visibility score (range: 0–3). The mean score of contrast effect and image effect of the two groups were compared by using Mann–Whitney U test. A p-value < 0.05 was considered statistically significant. Interobserver agreement was studied using Cohen kappa coefficient.
Results A total of 93 patients were eligible for the study. Forty-one patients were randomly assigned to the group that received only negative oral contrast and 52 group that received both ranitidine and negative oral contrast. The mean score of the images obtained with using both ranitidine and negative oral contrast was significantly higher when compared with the other group (3.02 vs. 2.7) (p-value = 0.018). However, there was no significant difference in mean structure visualization score of various parts of the pancreaticobiliary system. The interobserver agreement between the two readers in our study was acceptable.
Conclusion Combined use of hematinic syrup and ranitidine increases the image quality by improving the suppression of gastrointestinal fluid signal as compared with the use of only hematinic syrup as negative oral contrast.
Publication History
Article published online:
11 July 2022
© 2022. Indian Society of Gastrointestinal and Abdominal Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India
-
References
- 1 Bittman ME, Callahan MJ. The effective use of acai juice, blueberry juice and pineapple juice as negative contrast agents for magnetic resonance cholangiopancreatography in children. Pediatr Radiol 2014; 44 (07) 883-887
- 2 Bowes MT, Martin DF, Melling A. et al. Single dose oral ranitidine improves MRCP image quality: a double-blind study. Clin Radiol 2007; 62 (01) 53-57
- 3 Frisch A, Walter TC, Hamm B, Denecke T. Efficacy of oral contrast agents for upper gastrointestinal signal suppression in MRCP: a systematic review of the literature. Acta Radiol Open 2017; 6 (09) 2058460117727315
- 4 Renzulli M, Biselli M, Fabbri E. et al. What is the best fruit juice to use as a negative oral contrast agent in magnetic resonance cholangiopancreatography?. Clin Radiol 2019; 74 (03) 220-227
- 5 Arrivé L, Coudray C, Azizi L. et al. [Pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography]. J Radiol 2007; 88 (11 Pt 1): 1689-1694
- 6 Mohabir S, Pitcher RD, Perumal R, Goodier MDM. The efficacy of pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography. SA J Radiol 2020; 24 (01) 1875 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7433279/ cited 2020Nov28 [Internet]
- 7 Govindarajan A, Lakshmanan PM, Sarawagi R, Prabhakaran V. Evaluation of date syrup as an oral negative contrast agent for MRCP. AJR Am J Roentgenol 2014; 203 (05) 1001-1005
- 8 Clark K, Lam LT, Gibson S, Currow D. The effect of ranitidine versus proton pump inhibitors on gastric secretions: a meta-analysis of randomised control trials. Anaesthesia 2009; 64 (06) 652-657
- 9 Aboofazeli A, Shafaati A. Comparative bioavailability of ranitidine tablets in healthy volunteers. Iran J Pharm Res 2010; 0 (01) 1-6
- 10 Hendolin H, Suojaranta-Ylinen R, Alhava E. Effect of single-dose omeprazole and ranitidine on gastric juice acidity and volume in patients undergoing laparotomy. Acta Anaesthesiol Scand 1993; 37 (05) 484-487
- 11 Torres LR, Bretas EAS, Sauaia FilhoGA, Soares AFde F, D'Ippolito G. The role of ranitidine in the enhancement of imaging quality in magnetic resonance cholangiopancreatography. Radiol Bras 2013; 46 (02) 75-82
- 12 Morita S, Ueno E, Masukawa A. et al. Prospective comparative study of negative oral contrast agents for magnetic resonance cholangiopancreatography. Jpn J Radiol 2010; 28 (02) 117-122
- 13 Rinck PA, Myhr G, Smevik O, Borseth A. Oral magnetic particles as MR contrast agents for the gastrointestinal tract. RoFo Fortschr Geb Rontgenstr Nuklearmed 1992; 157 (06) 533-538
- 14 Lorenzen M, Wedegartner U, Fiehler J, Adam G. Quality rating of cholangiopancreatography with oral application of iron oxide particles. RoFo Fortschr Geb Rontgenstr Nuklearmed 2003; 175 (07) 936-941
- 15 Ghanaati H, Rokni-Yazdi H, Jalali AH, Abahashemi F, Shakiba M, Firouznia K. Improvement of MR cholangiopancreatography (MRCP) images after black tea consumption. Eur Radiol 2011; 21 (12) 2551-2557
- 16 Riordan RD, Khonsari M, Jeffries J, Maskell GF, Cook PG. Pineapple juice as a negative oral contrast agent in magnetic resonance cholangiopancreatography: a preliminary evaluation. Br J Radiol 2004; 77 (924) 991-999