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.

Comparison of the Efficacy of Diluted Polyethylene Glycol and Low-Density (0.1% w/v) Barium Sulfate Suspension for CT Enterography

“…In terms of the side effects discussed above, Singla et al ( 17 ) compared the side effects of four oral contrast agents with the same 1.5 L, specifically 3% mannitol solution, PEG solution, iohexol solution, and plain water prior to CTE. Among the side effects, nausea was the second most common in the PEG solution group after the iohexol solution group, and diarrhea was reported in eight patients in the mannitol group; however, this was not observed in the remaining groups.…”

“…Notably, sorbitol is an alternative contrast agent for CTE preparation ( 7 8 19 20 ); however, it is not easy to prepare a proper solution by mixing sorbitol powder with water prior to CTE. In addition to sorbitol, other neutral oral contrast agents used for small bowel distension include low-density (0.1% w/v) barium sulfate suspension, mannitol, and methylcellulose ( 7 8 17 18 19 20 ).…”

The added value of MDCT enterography using oral lactulose solution in detection, characterization, and guiding management of small bowel disorders

“…Water, whole milk, polyethylene glycol, and water with methyl cellulose, lactulose, and barium solution with sorbitol are among the many neutral and positive oral contrast agents used. Positive contrast agents may obscure fine details of mucosal enhancement and are usually limited to postoperative cases, suspected polyps, or webs [9].…”