CT Enterography Using Four Different Endoluminal Contrast Agents: A Comparative Study

Abstract

Objectives To determine the most preferable endoluminal contrast agent among mannitol, polyethylene glycol (PEG), iohexol, and water by comparing various qualitative (distension, fold visibility, and homogeneity) and quantitative parameters (distension) along with artifacts and patient feedback for computed tomography enterography (CTE).

Methods This was a prospective study including 120 patients of age more than or equal to 18 years who were randomized equally into four groups. Group 1 was given 1500 mL of 3% mannitol solution, group 2 was given 1500 mL of PEG, group 3 was given 20 mL of iohexol dissolved in 1500 mL of water, and group 4 was given 1500 mL of plain water. CTE was done and images were evaluated in axial and coronal planes. Various quantitative and qualitative parameters were taken at the level of second part of duodenum, jejunum, ileum and ileocecal junction (ICJ). Artifacts and patient feedback were also taken into consideration.

Results The quantitative distension and grading, qualitative distension, fold visibility, and homogeneity of the second part of duodenum, jejunum at the level of superior mesenteric artery, inferior mesenteric artery and renal artery on both sides of abdomen, ileum at the level of aortic bifurcation, common iliac bifurcation, and deep pelvis on both sides of abdomen and ICJ were significantly more in PEG group as compared with mannitol group, followed by iohexol and water group. The results were calculated by ANOVA test using p-value. In terms of patient feedback and artifacts, water was the best agent.

Conclusions PEG is the most suitable contrast agent to carry out CTE. Distension, fold visibility, and homogeneity are the essential features for a better diagnostic outcome of CTE, which was better with PEG.

Keywords

Intestine - Iohexol - Mannitol - multidetector computed tomography - polyethylene glycols - radiology

Publication History

Article published online:
11 June 2021

• References

• 1 Horton KM, Fishman EK. The current status of multidetector row CT and three-dimensional imaging of the small bowel. Radiol Clin North Am 2003; 41 (02) 199-212
• 2 Wong J, Moore H, Roger M, McKee C. CT enterography: mannitol versus VoLumen. J Med Imaging Radiat Oncol 2016; 60 (05) 593-598
• 3 Gale HI, Sharatz SM, Taphey M, Bradley WF, Nimkin K, Gee MS. Comparison of CT enterography and MR enterography imaging features of active Crohn disease in children and adolescents. Pediatr Radiol 2017; 47 (10) 1321-1328
• 4 Bruining DH, Fletcher JG. Computed tomography enterography. In: Gore RM, Levine MS. eds. Gastrointestinal Radiology. Philadelphia: Saunders; 2015: 684-685
• 5 Ha KH, Park SH, Lee SS. et al. Gastrointestinal tract.. In: Hagga JR, Boll DT. eds. CT and MRI of the Whole Body. Philadelphia: Elsevier; 2017: 1649-1650
• 6 Lim BK, Bux SI, Rahmat K, Lam SY, Liew YW. Evaluation of bowel distension and mural visualisation using neutral oral contrast agents for multidetector-row computed tomography. Singapore Med J 2012; 53 (11) 732-736
• 7 Macari M, Megibow AJ, Balthazar EJ. A pattern approach to the abnormal small bowel: observations at MDCT and CT enterography. AJR Am J Roentgenol 2007; 188 (05) 1344-1355
• 8 Megibow AJ, Babb JS, Hecht EM. et al. Evaluation of bowel distention and bowel wall appearance by using neutral oral contrast agent for multi-detector row CT. Radiology 2006; 238 (01) 87-95
• 9 Shanmuganathan K. Multi-detector row CT imaging of blunt abdominal trauma. Semin Ultrasound CT MR 2004; 25 (02) 180-204
• 10 Young BM, Fletcher JG, Booya F. et al. Head-to-head comparison of oral contrast agents for cross-sectional enterography: small bowel distention, timing, and side effects. J Comput Assist Tomogr 2008; 32 (01) 32-38
• 11 Wong J, Roger M, Moore H. Performance of two neutral oral contrast agents in CT enterography. J Med Imaging Radiat Oncol 2015; 59 (01) 34-38
• 12 Minordi LM, Vecchioli A, Mirk P, Bonomo L. CT enterography with polyethylene glycol solution vs CT enteroclysis in small bowel disease. Br J Radiol 2011; 84 (998) 112-119
• 13 Hebert JJ, Taylor AJ, Winter TC, Reichelderfer M, Weichert JP. Low-attenuation oral GI contrast agents in abdominal-pelvic computed tomography. Abdom Imaging 2006; 31 (01) 48-53
• 14 Thompson SE, Raptopoulos V, Sheiman RL, McNicholas MM, Prassopoulos P. Abdominal helical CT: milk as a low-attenuation oral contrast agent. Radiology 1999; 211 (03) 870-875
• 15 Allen TL, Mueller MT, Bonk RT, Harker CP, Duffy OH, Stevens MH. Computed tomographic scanning without oral contrast solution for blunt bowel and mesenteric injuries in abdominal trauma. J Trauma 2004; 56 (02) 314-322
• 16 Lee CH, Haaland B, Earnest A, Tan CH. Use of positive oral contrast agents in abdominopelvic computed tomography for blunt abdominal injury: meta-analysis and systematic review. Eur Radiol 2013; 23 (09) 2513-2521
• 17 Prakashini K, Kakkar C, Sambhaji C, Shetty CM, Rao VR. Quantitative and qualitative bowel analysis using mannitol, water and iodine-based endoluminal contrast agent on 64-row detector CT. Indian J Radiol Imaging 2013; 23 (04) 373-378
• 18 Zhang LH, Zhang SZ, Hu HJ. et al. Multi-detector CT enterography with iso-osmotic mannitol as oral contrast for detecting small bowel disease. World J Gastroenterol 2005; 11 (15) 2324-2329
• 19 Wang YR, Yu XL, Peng ZY. Evaluation of different small bowel contrast agents by multi - detector row CT. Int J Clin Exp Med 2015; 8 (09) 16175-16182
• 20 Elamparidhi P, Sivaranjanie S, Kumar RR. et al. Comparison of water, mannitol and positive oral contrast for evaluation of bowel by computed tomography. Int J Anat Radiol Surg 2017; 6: 13-17
• 21 Zheng MQ, Zeng QS, Yu YQ. et al. Evaluation of the performance of two neutral oral contrast agents in computed tomography enterography: a randomized controlled trial. J Dig Dis 2020; 21 (02) 112-119