Purpose To compare total colonic gas volume and segmental luminal distention according to patient position at CT colonography (CTC), and determine which two views should constitute the routine protocol. Methods Volumetric analysis was retrospectively performed on CTC examinations from 146 adults (mean age, 59.2 years; 81M/65F; mean BMI, 30.9) where supine, prone, and right lateral decubitus series were sequentially obtained using continuous low-pressure CO2 insufflation. Total colonic gas volumes were assessed using a novel automated volumetric tool. In addition, two radiologists scored distention by segment using a 4-point scale (4=Optimal/3=Adequate/2=Inadequate/1=Collapsed). Results Mean colonic gas volume (±SD) for supine, prone, and decubitus positioning was 1,617±567 ml, 1441±505 ml, and 1901±627 ml, respectively (p<0.001). Colonic volume was highest on the right lateral decubitus series in 73.3% (107/146) and lowest in 6.2% (9/146) of cases, whereas the prone series was highest in 0.7% (1/146) and lowest in 73.3% (107/146) of cases. Overall mean segmental reader scores and % inadequate/collapsed for supine, prone, and decubitus positions were 3.48/3.33/3.71, and 10.4%/12.1%/4.2%, respectively (p<0.001). The only mean segmental scores below 3.0 were the sigmoid on supine (2.68) and prone (2.58), compared with 3.23 on decubitus (p<0.001). Improvement in both decubitus and supine distention over prone increased further with increasing BMI (p<0.001). Conclusions The right lateral decubitus position consistently yields the best colonic distention at CTC, and significantly improves sigmoid evaluation. Prone distention was the worst, particularly as BMI increased. Routine supine and decubitus positioning should be considered for standard CTC protocols, particularly in obese individuals. Automated volumetric analysis provides for rapid objective assessment of colonic distention.

AIM To perform an objective, intra-individual comparison of residual colonic fluid volume and attenuation associated with the current front-line laxative magnesium citrate (MgC) versus the former front-line laxative sodium phosphate (NaP) at CT colonography (CTC). MATERIALS AND METHODS This retrospective Health Insurance and Portability and Accountability Act-compliant study had institutional review board approval; informed consent was waived. The study cohort included 250 asymptomatic adults (mean age at index 56.1 years; 124 male/126 female) who underwent CTC screening twice over a 5 year interval. Colon catharsis at initial and follow-up screening employed single-dose NaP and double-dose MgC, respectively, allowing for intra-patient comparison. Automated volumetric analysis of residual colonic fluid volume and attenuation was performed on all 500 CTC studies. Colonic fluid volume <200 ml and mean attenuation between 300–900 HU were considered optimal. Paired t-test and McNemar’s test were used to compare differences. RESULTS Residual fluid volumes <200 ml were recorded in 192 examinations (76.8%) following MgC and in 204 examinations (81.6%) following NaP (p=0.23). The mean total residual fluid volume was 155±114 ml for MgC and 143±100 ml for NaP (p=0.01). The attenuation range of 300–900 HU was significantly more frequent for MgC (n=220, 88%) than for NaP (n=127, 50.8%; p<0.001). Mean fluid attenuation was significantly lower for MgC (700±165 HU) than for NaP (878±155 HU; p<0.001). Concomitant presence of both optimal fluid volume and attenuation was significantly more frequent for MgC 65.2% than for NaP (38%; p<0.001). CONCLUSIONS Objective intra-individual comparison using automated volumetric analysis suggests that the replacement of NaP by MgC as the front-line laxative for CTC has not compromised overall examination quality.

Purpose To objectively compare residual colonic fluid volume and attenuation of oral sulfate solution (OSS) with four different established cathartic regimens using an automated volumetric software tool at CT colonography (CTC). Methods This HIPAA-compliant study had institutional review board approval. Volumetric analysis of residual contrast-tagged colonic fluid was performed on CTC studies in 263 adults (mean age, 60.1 years; 137M/126F) using an automated volumetric software tool. 23 patients receiving 177 ml OSS (SUPREP; single-bottle purgation) were compared with 60 patients each receiving 45 ml sodium phosphate (NaP), 90 ml NaP (2xNaP), 592 ml (two bottles) magnesium citrate (MgC), and 4000 ml polyethylene glycol (PEG). All patients received oral contrast cleansing after catharsis. Data were analyzed with unpaired t test with Welch correction and F test. Results The mean volume of residual colonic fluid was less with OSS (125±60 ml) than for established cathartic agents: 2xNaP (206±125 ml, (p<0.0001), MgC (184±125 ml, p<0.01), PEG (166±114 ml, p<0.05) and NaP (165±135 ml, p=0.067). Variance of volumes was also significantly lower for OSS (range, 28 – 251 ml) than for established agents (range, 4 – 853 ml) (all p<0.01). Mean fluid attenuation was higher with OSS (956±168 HU) than for established agents (all p<0.05): 2xNaP (455±191 HU), MgC (691±154 HU), NaP (779±127 HU), and PEG (843±193 HU). Conclusions Automated volumetry allows rapid objective assessment of bowel preparation quality at CTC. Purgation with the novel oral sulfate solution (SUPREP) consistently resulted in less residual colonic fluid and higher fluid attenuation compared with established cathartic regimens.

Molluscum contagiosum (MC) is a common, self-limited skin infection caused by a double-stranded DNA virus of the family Poxviridae. Although the morphology of the disease is well described, MC presenting at unusual sites can exhibit atypical morphology, resulting in misdiagnosis. This observational, retrospective case series discusses the novel morphology of MC presenting in the intergluteal cleft of five children seen in the outpatient dermatology clinic of an academic medical center. We present this case series to highlight this novel presentation of MC in children and to emphasize a conservative approach to management given the sensitive location and the self-limited nature of the infection.