Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
European Radiology
Published in: European Radiology 3/2015

01-03-2015 | Computed Tomography

Abdominal and pelvic CT: is positive enteric contrast still necessary? Results of a retrospective observational study

Authors: S. Kammerer, A. J. Höink, J. Wessling, H. Heinzow, R. Koch, C. Schuelke, W. Heindel, B. Buerke

Published in: European Radiology | Issue 3/2015

Login to get access

Abstract

Purpose

Evaluation of diagnostic accuracy of abdominal CT depending on the type of enteric contrast agent.

Methods and materials

Multislice CTs of 2,008 patients with different types of oral preparation (positive with barium, n = 576; neutral with water, n = 716; and no enteric contrast, n = 716) were retrospectively evaluated by two radiologists including delineation of intestinal segments and influence on diagnosis and diagnostic reliability exerted by the enteric contrast, using a three-point scale. Furthermore, diagnostic reliability of the delineation of selected enteric pathologies was noted. CT data were assigned into groups: oncology, inflammation, vascular, pathology, trauma and gastrointestinal pathology.

Results

Delineation of the bowel was clearly practicable across all segments irrespective of the type of enteric contrast, though a slight impairment was observed without enteric contrast. Although delineation of intestinal pathologies was mostly classified “clearly delimitable” more difficulties occurred without oral contrast (neutral/positive/no contrast, 0.8 %/3.8 %/6.5 %). Compared to examinations without enteric contrast, there was a significant improvement in diagnosis that was even increased regarding the reader’s diagnostic reliability. Positive opacification impaired detection of mucosal enhancement or intestinal bleeding.

Conclusion

Water can replace positive enteric contrast agents in abdominal CTs. However, selected clinical questions require individual enteric contrast preparations. Pathology detection is noticeably impaired without any enteric contrast.

Key Points

• Neutral oral contrast ensures an equivalent delineation of the bowel.
• Neutral contrast ensures a similar detection rate for intestinal pathologies.
• Positive enteric contrast should be used in selected questions (suspected fistulas, abscesses).
• Detection of pathologies and bowel delineation proved more difficult without oral contrast.
• Diagnosis and the reporting physician’s diagnostic reliability are impaired without enteric contrast.
Literature
1.
Atri M, Hanson JM, Grinblat L et al (2008) Surgically important bowel and/or mesenteric injury in blunt trauma: accuracy of multidetector CT for evaluation. Radiology 249:524–533CrossRefPubMed
2.
3.
Furukawa A, Yamasaki M, Furuichi K et al (2001) Helical CT in the diagnosis of small bowel obstruction. Radiographics 21:341–355CrossRefPubMed
4.
Erturk SM, Mortele KJ, Oliva MR et al (2008) Depiction of normal gastrointestinal anatomy with MDCT: comparison of low- and high-attenuation oral contrast media. Eur J Radiol 66:84–87CrossRefPubMed
5.
6.
7.
Diederichs G, Franiel T, Asbach P et al (2007) Oral administration of intravenous contrast media: a tasty alternative to conventional oral contrast media in computed tomography. Rofo 179:1061–1067CrossRefPubMed
8.
Megibow AJ, Babb JS, Hecht EM et al (2006) Evaluation of bowel distention and bowel wall appearance by using neutral oral contrast agent for multi-detector row CT. Radiology 238:87–95CrossRefPubMed
9.
Harieaswar S, Rajesh A, Griffin Y et al (2009) Routine use of positive oral contrast material is not required for oncology patients undergoing follow-up multidetector CT. Radiology 250:246–253CrossRefPubMed
10.
Paulsen SR, Huprich JE, Fletcher JG et al (2006) CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases. Radiographics 26:641–657, discussion 57–62CrossRefPubMed
11.
Hamilton JD, Kumaravel M, Censullo ML et al (2008) Multidetector CT evaluation of active extravasation in blunt abdominal and pelvic trauma patients. Radiographics 28:1603–1616CrossRefPubMed
12.
Wittenberg J, Harisinghani MG, Jhaveri K et al (2002) Algorithmic approach to CT diagnosis of the abnormal bowel wall. Radiographics 22:1093–1107, discussion 107–109CrossRefPubMed
13.
Levenson RB, Camacho MA, Horn E et al (2012) Eliminating routine oral contrast use for CT in the emergency department: impact on patient throughput and diagnosis. Emerg Radiol 19:513–517CrossRefPubMed
14.
Anderson BA, Salem L, Flum DR (2005) A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults. Am J Surg 190:474–478CrossRefPubMed
15.
Balthazar EJ, Birnbaum BA, Yee J et al (1994) Acute appendicitis: CT and US correlation in 100 patients. Radiology 190:31–35CrossRefPubMed
16.
Bendeck SE, Nino-Murcia M, Berry GJ, Jeffrey RB Jr (2002) Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology 225:131–136CrossRefPubMed
17.
Hebert JJ, Taylor AJ, Winter TC (2006) Comparison of colonic transit between polyethylene glycol and water as oral contrast vehicles in the CT evaluation of acute appendicitis. AJR Am J Roentgenol 187:1188–1191CrossRefPubMed
18.
Guimaraes LS, Fidler JL, Fletcher JG et al (2010) Assessment of appropriateness of indications for CT enterography in younger patients. Inflamm Bowel Dis 16:226–232CrossRefPubMed
19.
Hara AK, Alam S, Heigh RI et al (2008) Using CT enterography to monitor Crohn's disease activity: a preliminary study. AJR Am J Roentgenol 190:1512–1516CrossRefPubMed
20.
Reittner P, Goritschnig T, Petritsch W et al (2002) Multiplanar spiral CT enterography in patients with Crohn's disease using a negative oral contrast material: initial results of a noninvasive imaging approach. Eur Radiol 12:2253–2257CrossRefPubMed
21.
Shankar KR, Lloyd DA, Kitteringham L, Carty HM (1999) Oral contrast with computed tomography in the evaluation of blunt abdominal trauma in children. Br J Surg 86:1073–1077CrossRefPubMed
22.
Koo CW, Shah-Patel LR, Baer JW, Frager DH (2008) Cost-effectiveness and patient tolerance of low-attenuation oral contrast material: milk versus VoLumen. AJR Am J Roentgenol 190:1307–1313CrossRefPubMed
23.
Hundt W, Rust F, Stabler A et al (2005) Dose reduction in multislice computed tomography. J Comput Assist Tomogr 29:140–147CrossRefPubMed
24.
Iball GR, Brettle DS, Moore AC (2006) Assessment of tube current modulation in pelvic CT. Br J Radiol 79:62–70CrossRefPubMed
25.
Buerke B, Puesken M, Beyer F (2010) Semiautomatic lymph node segmentation in multislice computed tomography: impact of slice thickness on segmentation quality, measurement precision, and interobserver variability. Invest Radiol 45:82–88CrossRefPubMed
26.
Peyrin-Biroulet L, Bronowicki JP, Bigard MA et al (2006) Contribution of computed tomography with oral media contrast to the diagnosis of esophago-pericardial fistula. Clin Imaging 30:347–349CrossRefPubMed
27.
Pickhardt PJ, Bhalla S, Balfe DM (2002) Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. Radiology 224:9–23CrossRefPubMed
28.
O'Connor SD, Summers RM (2007) Revisiting oral barium sulfate contrast agents. Acad Radiol 14:72–80CrossRefPubMed
29.
Hebert JJ, Taylor AJ, Winter TC et al (2006) Low-attenuation oral GI contrast agents in abdominal-pelvic computed tomography. Abdom Imaging 31:48–53CrossRefPubMed
30.
Horton KM, Fishman EK (2004) Multidetector-row computed tomography and 3-dimensional computed tomography imaging of small bowel neoplasms: current concept in diagnosis. J Comput Assist Tomogr 28:106–116CrossRefPubMed
31.
Angelelli G, Macarini L, Fratello A (1987) Use of water as an oral contrast agent for CT study of the stomach. AJR Am J Roentgenol 149:1084CrossRefPubMed
32.
Kong DG, Hou YF, Ma LL et al (2012) Comparison of oral and intravenous hydration strategies for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography or angioplasty: a randomized clinical trial. Acta Cardiol 67:565–569PubMed
Metadata
Title
Abdominal and pelvic CT: is positive enteric contrast still necessary? Results of a retrospective observational study
Authors
S. Kammerer
A. J. Höink
J. Wessling
H. Heinzow
R. Koch
C. Schuelke
W. Heindel
B. Buerke
Publication date
01-03-2015
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 3/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-014-3446-9

Other articles of this Issue 3/2015

European Radiology 3/2015 Go to the issue

Breast

Does digital mammography suppose an advance in early diagnosis? Trends in performance indicators 6 years after digitalization

Breast

Intraindividual, randomized comparison of the macrocyclic contrast agents gadobutrol and gadoterate meglumine in breast magnetic resonance imaging

Computed Tomography

Assessment of image quality and low-contrast detectability in abdominal CT of obese patients: comparison of a novel integrated circuit with a conventional discrete circuit detector at different tube voltages

Musculoskeletal

An update on risk factors for cartilage loss in knee osteoarthritis assessed using MRI-based semiquantitative grading methods

Musculoskeletal

Semiautomatic superimposition improves radiological assessment of curve flexibility in scoliosis

Breast

Dixon imaging-based partial volume correction improves quantification of choline detected by breast 3D-MRSI