MRI of the small bowel: can sufficient bowel distension be achieved with small volumes of oral contrast?

Kinner, Sonja; Kuehle, Christiane A.; Herbig, S.; Haag, Sebastian; Ladd, Susanne C.; Barkhausen, Joerg; Lauenstein, Thomas C.

doi:10.1007/s00330-008-1041-7

Cited by 24 publications

(17 citation statements)

References 22 publications

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“…The mixture is tasteless, and fruit cordial can be added for flavor, depending on patient preference. Although we aim for a total of 1.5 L, some patients cannot tolerate this volume, and adequate results may still be achieved with as little as 500 mL (34). For this reason, we usually perform the examination even if only a small volume has been ingested.…”

Section: Other Indicationsmentioning

confidence: 95%

MR Enterographic Manifestations of Small Bowel Crohn Disease

Tolan¹,

Greenhalgh²,

Zealley³

et al. 2010

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Magnetic resonance (MR) enterography is a clinically useful technique for the evaluation of both intraluminal and extraluminal small bowel disease, particularly in younger patients with Crohn disease. MR enterography offers the advantages of multiplanar capability and lack of ionizing radiation. It allows evaluation of bowel wall contrast enhancement, wall thickening, and edema, findings useful for the assessment of Crohn disease activity. MR enterography can also depict other pathologic findings such as lymphadenopathy, fistula and sinus formation, abscesses, and abnormal fold patterns. Even subtle disease manifestations may be detected when adequate distention of the small bowel is achieved, although endoscopic and double-contrast barium small bowel techniques remain superior in the depiction of changes in early Crohn disease (eg, aphthoid ulceration). Further research will be needed to determine whether MR imaging enhancement patterns may reliably help discriminate between active and inactive disease.

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Section: Other Indicationsmentioning

confidence: 95%

MR Enterographic Manifestations of Small Bowel Crohn Disease

Tolan¹,

Greenhalgh²,

Zealley³

et al. 2010

RadioGraphics

220

169

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“…There was no consensus as to whether the oral contrast agent should be split into two aliquots prior to ingestion or drunk continuously, and both approaches seem acceptable. Although there is evidence that examinations of reasonable quality can be achieved with as little as 450 ml of oral contrast agent [16], no consensus was reached on the minimum oral contrast load for acceptable MRE or CTE and in clinical practice this is usually judged on a case by case basis. Plugging of a stoma is recommended to improve enteric distension, but there is no direct scientific evidence to support this approach.…”

Section: Discussionmentioning

confidence: 99%

The first joint ESGAR/ ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging

et al. 2016

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ObjectivesTo develop guidelines describing a standardised approach to patient preparation and acquisition protocols for magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound (US) of the small bowel and colon, with an emphasis on imaging inflammatory bowel disease.MethodsAn expert consensus committee of 13 members from the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and European Society of Paediatric Radiology (ESPR) undertook a six-stage modified Delphi process, including a detailed literature review, to create a series of consensus statements concerning patient preparation, imaging hardware and image acquisition protocols.ResultsOne hundred and fifty-seven statements were scored for agreement by the panel of which 129 statements (82 %) achieved immediate consensus with a further 19 (12 %) achieving consensus after appropriate modification. Nine (6 %) statements were rejected as consensus could not be reached.ConclusionsThese expert consensus recommendations can be used to help guide cross-sectional radiological practice for imaging the small bowel and colon.Key points• Cross-sectional imaging is increasingly used to evaluate the bowel • Image quality is paramount to achieving high diagnostic accuracy • Guidelines concerning patient preparation and image acquisition protocols are provided

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“…1,18 There have also been studies attempting to optimize bowel distension using sorbitol without decreasing patient tolerability with different volumes and concentrations. 2 Benefits of sorbitol are that it has been shown to provide good distension and is biphasic, inexpensive, easy to store and commercially available in many countries.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 3% sorbitolvspsyllium fibre as oral contrast agents in MR enterography

Saini

Colak

Anthwal

et al. 2014

BJR

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Objective: To compare the degree of small bowel distension achieved by 3% sorbitol, a high osmolarity solution, and a psyllium-based bulk fibre as oral contrast agents (OCAs) in MR enterography (MRE). Methods: This retrospective study was approved by our institutional review board. A total of 45 consecutive normal MRE examinations (sorbitol, n 5 20; psyllium, n 5 25) were reviewed. The patients received either 1.5 l of 3% sorbitol or 2 l of 1.6 g kg 21 psyllium prior to imaging.Quantitative small bowel distension measurements were taken in five segments: proximal jejunum, distal jejunum, proximal ileum, distal ileum and terminal ileum by two independent radiologists. Distension in these five segments was also qualitatively graded from 0 (very poor) to 4 (excellent) by two additional independent radiologists. Statistical analysis comparing the groups and assessing agreement included intraclass coefficients, Student's t-test and Mann-Whitney U-test.Results: Small bowel distension was not significantly different in any of the five small bowel segments between the use of sorbitol and psyllium as OCAs in both the qualitative (p 5 0.338-0.908) and quantitative assessments (p 5 0.083-0.856). The mean bowel distension achieved was 20.1 6 2.2 mm for sorbitol and 19.8 6 2.5 mm for psyllium (p 5 0.722). Visualization of the ileum was good or excellent in 65% of the examinations in both groups. Conclusion: Sorbitol and psyllium are not significantly different at distending the small bowel and both may be used as OCAs for MRE studies. Advances in knowledge: This is the first study to directly compare the degree of distension in MRE between these two common, readily available and inexpensive OCAs.MR enterography (MRE) is an imaging technique used to evaluate the small bowel for diagnoses that include inflammatory bowel disease and neoplasms. Sufficiently distending the small bowel with an oral contrast agent (OCA) is critical, as collapsed loops may hide or mimic abnormalities.The OCAs employed in MRE can be classified as positive, negative or biphasic contrast agents according to their signal properties on T 1 and T 2 weighted imaging. Biphasic contrast agents typically provide low signal intensity on T 1 weighted imaging and high signal intensity on T 2 weighted imaging (T2W), and are most commonly used today because of their favourable signal characteristics for detecting bowel pathology. Water is a biphasic contrast agent, but its rapid physiological absorption from the small bowel necessitates the use of additives. These additives are often highly osmolar agents or non-osmotic agents that form hydrogels that trap water molecules in the bowel lumen. Combinations of highly osmolar agents and non-osmotic agents are also frequently used, as in the case of sorbitol and locust bean gum. 1,2Ideally, the chosen contrast agent should (i) provide adequate distension of the entire small bowel, (ii) provide uniform and homogenous opacification of the lumen, (iii) provide good delineation of the bowel wall, (iv) be below cost and eas...

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MRI of the small bowel: can sufficient bowel distension be achieved with small volumes of oral contrast?

Cited by 24 publications

References 22 publications

MR Enterographic Manifestations of Small Bowel Crohn Disease

MR Enterographic Manifestations of Small Bowel Crohn Disease

The first joint ESGAR/ ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging

Comparison of 3% sorbitolvspsyllium fibre as oral contrast agents in MR enterography

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