Bowel Preparation for CT Colonography: Blinded Comparison of Magnesium Citrate and Sodium Phosphate for Catharsis

Borden, Zachary; Pickhardt, Perry J.; Kim, David H.; Lubner, Meghan G.; Agriantonis, D.J.; Hinshaw, J. Louis

doi:10.1148/radiol.09090398

Cited by 37 publications

(32 citation statements)

References 17 publications

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“…Reducing bowel preparation volume may increase patient compliance with CT colonographic screening ( 14,15 ). Feasibility studies involving limited bowel preparation have shown promising results (16)(17)(18)(19)(20)(21)(22)(23)(24)(25). Magnesium citrate, a low-volume osmotic laxative, is an effective small-volume bowel preparation, but its use may lead to adherent residual solid stool and thereby prolong interpretation times ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

“…Researchers in previous studies have compared reduced-volume PEG with standard 4-L PEG preparations (31)(32)(33), reduced-volume PEG with small-volume sodium phosphate preparations ( 26,34,35 ), magnesium citrate combined with sodium phosphate with magnesium citrate alone ( 36 ) or 4-L PEG ( 37 ), and mag nesium citrate with sodium phosphate ( 25,38,39 ). To our knowledge, the reduced-volume PEG preparation has not been directly compared with the magnesium citrate preparation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Reduced Cathartic Bowel Preparation for CT Colonography: Prospective Comparison of 2-L Polyethylene Glycol and Magnesium Citrate

Keedy¹,

Yee²,

Aslam³

et al. 2011

Radiology

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Purpose:To prospectively compare adequacy of colonic cleansing, adequacy of solid stool and fl uid tagging, and patient acceptance by using reduced-volume, 2-L polyethylene glycol (PEG) versus magnesium citrate bowel preparations for CT colonography. Materials and Methods:This study was approved by the institutional Committee on Human Research and was compliant with HIPAA; all patients provided written consent. In this randomized, investigatorblinded study, 50 patients underwent oral preparation with either a 2-L PEG or a magnesium citrate solution, tagging with oral contrast agents, and subsequent CT colonography and segmentally unblinded colonoscopy .

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reduced Cathartic Bowel Preparation for CT Colonography: Prospective Comparison of 2-L Polyethylene Glycol and Magnesium Citrate

Keedy¹,

Yee²,

Aslam³

et al. 2011

Radiology

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“…In summary, patients underwent a low-volume bowel preparation on the day prior to CT colonography by using a cathartic cleansing agent. Magnesium citrate was used at repeat CT colonography screening in 1379 (96.5%) of 1429 patients, with polyethylene glycol used in most of the remaining patients (14). Oral contrast material tagging of residual fecal material was achieved with 2.1% weight per volume barium sulfate, and fluid tagging was achieved with either diatrizoate or iohexol iodinated contrast material (15).…”

Section: Ct Colonography Technique and Interpretationmentioning

confidence: 99%

Colorectal Findings at Repeat CT Colonography Screening after Initial CT Colonography Screening Negative for Polyps Larger than 5 mm

Pickhardt¹,

Pooler²,

Mbah³

et al. 2017

Radiology

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Purpose:To determine the rate and types of polyps detected at repeat computed tomographic (CT) colonography screening after initial negative findings at CT colonography screening. Materials and Methods:Among 5640 negative CT colonography screenings (no polyps  6 mm) performed before 2010 at one medical center, 1429 (25.3%; mean age, 61.4 years; 736 women, 693 men) patients have returned for repeat CT colonography screening (mean interval, 5.7 years 6 0.9; range, 4.5-10.7 years). Positive rates and histologic findings of initial and repeat screening were compared in this HIPAAcompliant, institutional review board-approved study. For all patients with positive findings at repeat CT colonography, the findings were directly compared against the initial CT colonography findings. Fisher exact, Pearson x 2 , and Student t tests were applied as indicated. Results:Repeat CT colonography screening was positive for lesions 6 mm or larger in 173 (12.1%) adults (compared with 14.3% at initial CT colonography screening, P = .29).In the 173 patients, 29.5% (61 of 207) of nondiminutive polyps could be identified as diminutive at the initial CT colonography and 12.6% (26 of 207) were missed. Large polyps, advanced neoplasia (advanced adenomas and cancer), and invasive cancer were seen in 3.8% (55 of 1429), 2.8% (40 of 1429), and 0.14% (two of 1429), respectively, at follow-up, compared with 5.2% (P = .02), 3.2% (P = .52), and 0.45% (P = .17), respectively, at initial screening. Of 42 advanced lesions in 40 follow-up screenings, 33 (78.6%) were right sided and 22 (52.4%) were flat, compared with 45.4% (P , .001) and 11.3% (P , .001), respectively, at initial screening. Large right-sided serrated lesions were confirmed in 20 individuals (1.4%), compared with 0.5% (P , .001) confirmed at initial screening. Conclusion:Positive rates for large polyps at repeat CT colonography screening (3.7%) were lower compared with those at initial screening (5.2%). However, more advanced rightsided lesions were detected at follow-up CT colonography, many of which were flat, serrated lesions. The cumulative findings support both the nonreporting of diminutive lesions and a 5-10-year screening interval.q RSNA, 2016

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“…A prior study revealed that both the current standard MgC regimen and the previous NaP regimen resulted in excellent bowel preparation in terms of residual adherent stool, whereas MgC yielded more favourable fluid attenuation than NaP (19). Moreover, using a cumbersome, subjective and insensitive semi-quantitative scoring system, the authors found no significant difference between the residual fluid volumes for the cathartic agents (19).…”

Section: Introductionmentioning

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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Bowel Preparation for CT Colonography: Blinded Comparison of Magnesium Citrate and Sodium Phosphate for Catharsis

Cited by 37 publications

References 17 publications

Reduced Cathartic Bowel Preparation for CT Colonography: Prospective Comparison of 2-L Polyethylene Glycol and Magnesium Citrate

Reduced Cathartic Bowel Preparation for CT Colonography: Prospective Comparison of 2-L Polyethylene Glycol and Magnesium Citrate

Colorectal Findings at Repeat CT Colonography Screening after Initial CT Colonography Screening Negative for Polyps Larger than 5 mm

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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