Automated volumetric analysis for comparison of oral sulfate solution (SUPREP) with established cathartic agents at CT colonography

Bannas, Peter; Bakke, Joshua R.; Patrick, James L.; Pickhardt, Perry J.

doi:10.1007/s00261-014-0186-x

Cited by 7 publications

(8 citation statements)

References 34 publications

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“…There was a statistically significant difference in residual colonic fluid volume between diatrizoate and iohexol groups, with iohexol resulting in slightly more fluid on average. Despite this difference, both regimens resulted in residual fluid volumes predominantly in the optimal range of less than 200 mL and therefore our group did not consider this difference to be clinically meaningful [5, 6]. …”

Section: Discussionmentioning

confidence: 99%

“…Based on our previous experience with volumetric analysis of residual colonic fluid at CTC, we prefer to have less than 200 ml of residual luminal fluid to allow for efficient and effective 3D fly-through evaluation [5, 6]. In terms of fluid density for 2D evaluation, we prefer an attenuation value greater than 500 HU [5, 6]. Finally, adherent stool must be minimized to allow for a primary 3D polyp evaluation [14].…”

Section: Methodsmentioning

confidence: 99%

“…The total volume and mean attenuation of the residual luminal colonic fluid for each patient were derived using an automated quality assessment (QA) tool available on a beta version of our CTC software system (V3D Colon, Viatronix) that provides the luminal fluid and gas volumes [5, 6, 19]. This portion of the study was conducted by one of the co-authors (B.J.…”

Section: Methodsmentioning

confidence: 99%

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Objective and Subjective Intrapatient Comparison of Iohexol Versus Diatrizoate for Bowel Preparation Quality at CT Colonography

Johnson

Hinshaw

Robbins

et al. 2016

American Journal of Roentgenology

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Objective To objectively and subjectively compare nonionic iohexol and ionic diatrizoate iodinated oral contrast as part of a cathartic bowel regimen within the same CT colonography (CTC) cohort, with otherwise identical preparations. Materials and Methods In our IRB-approved retrospective study, 46 asymptomatic adults (mean age, 59.4 years; 26M/20F) returning for follow-up CTC over a 9-month interval underwent the same bowel preparation with the exception of 75 ml iohexol 350 (Omnipaque) in place of 60 ml diatrizoate (Gastrografin). All other preparation components (bisacodyl, magnesium citrate, and 2% barium) remained constant. Objective volumetric analysis of residual colonic fluid volume and fluid attenuation was performed. Additionally, two radiologists experienced with CTC, blinded to the specific bowel preparation, scored each of 6 colonic segments for adherent residual solid stool using a previously validated 4-point scale (0 for no stool; 1–3 for increasing residual stool). Paired t-test was used for comparison of the cohorts. Results No clear clinically-meaningful difference was found between the two preparations on overall objective or subjective evaluation. Mean (±SD) residual fluid volume was 173±126 ml with the iohexol preparation and 130±79 ml with the diatrizoate prep (p=0.02). Mean total colonic stool score was 2.5 (0.42/segment) with iohexol and 2.3 (0.38/segment) with diatrizoate (p=0.69). Mean (±SD) fluid attenuation was higher with iohexol (849±270HU) compared with diatrizoate (732±168HU) (p=0.03). Conclusions Based on this direct intra-patient comparison, we found that oral iohexol is a suitable alternative to diatrizoate for fluid tagging as part of a cathartic bowel preparation at CTC. Because this nonionic tagging agent is more palatable, less expensive, and likely safer than ionic diatrizoate, our CTC program now utilizes iohexol as the standard recommended regimen.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Objective and Subjective Intrapatient Comparison of Iohexol Versus Diatrizoate for Bowel Preparation Quality at CT Colonography

Johnson

Hinshaw

Robbins

et al. 2016

American Journal of Roentgenology

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“…The algorithm for QA fluid detection has been described in prior publications (18, 19). In brief, proper processing required correct centerline generation and colonic segmentation.…”

Section: Methodsmentioning

confidence: 99%

CT colonography after incomplete optical colonoscopy: bowel preparation quality at same-day vs. deferred examination

et al. 2015

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Purpose To objectively compare the volume, density, and distribution of luminal fluid for same-day oral-contrast-enhanced CTC following incomplete optical colonoscopy (OC) versus deferred CTC on a separate day utilizing a dedicated CTC bowel preparation. Methods HIPAA-compliant, IRB-approved retrospective study compared 103 same-day CTC studies after incomplete OC (utilizing 30 ml oral diatrizoate) against 151 CTC examinations performed on a separate day after failed OC using a dedicated CTC bowel preparation (oral magnesium citrate/dilute barium/diatrizoate the evening before). A subgroup of 15 patients who had both same-day CTC and separate-day routine CTC was also identified and underwent separate analysis. CTC exams were analyzed for opacified fluid distribution within the GI tract, as well as density and volume. Data was analyzed utilizing Kruskal-Wallis and Wilcoxon Signed Rank tests. Results Opacified luminal fluid extended to the rectum in 56% (58/103) of same-day CTC versus 100% (151/151) of deferred separate-day CTC (p<0.0001). For same-day CTC, contrast failed to reach the colon in 11% (11/103) and failed to reach the left colon in 26% (27/103). Volumetric colonic fluid segmentation for fluid analysis (successful in 80 same-day and 147 separate-day cases) showed significantly more fluid in the same-day cohort (mean, 227 ml vs. 166 ml; p<0.0001); the actual difference is underestimated due to excluded cases. Mean colonic fluid attenuation was significantly lower in the same-day cohort (545 HU vs. 735 HU; p<0.0001). Similar findings were identified in the smaller cohort with direct intra-patient CTC comparison. Conclusions Dedicated CTC bowel preparation on a separate day following incomplete OC results in a much higher quality examination compared with same-day CTC.

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“…McNemar’s test was performed to compare the total numbers of optimal versus suboptimal NaP und MgC preparations regarding the total volume and/or attenuation of residual fluid. Total residual colonic fluid volumes <200 ml were defined as excellent based on a recent study comparing four different cathartic agents (25). Regarding colonic fluid attenuation, mean values >300 HU were defined as insufficient tagging of residual fluid (12) and mean values >900 HU were defined as too high (13).…”

Section: Methodsmentioning

confidence: 99%

Intra-individual comparison of magnesium citrate and sodium phosphate for bowel preparation at CT colonography: Automated volumetric analysis of residual fluid for quality assessment

et al. 2014

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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.

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Automated volumetric analysis for comparison of oral sulfate solution (SUPREP) with established cathartic agents at CT colonography

Cited by 7 publications

References 34 publications

Objective and Subjective Intrapatient Comparison of Iohexol Versus Diatrizoate for Bowel Preparation Quality at CT Colonography

Objective and Subjective Intrapatient Comparison of Iohexol Versus Diatrizoate for Bowel Preparation Quality at CT Colonography

CT colonography after incomplete optical colonoscopy: bowel preparation quality at same-day vs. deferred examination

Intra-individual comparison of magnesium citrate and sodium phosphate for bowel preparation at CT colonography: Automated volumetric analysis of residual fluid for quality assessment

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