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

Abstract

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.

Core–multi-shell design: unlocking multimodal capabilities in lanthanide-based nanoparticles as upconverting, T2-weighted MRI and CT probes

“…This is expected given the optimized performance of iohexol at lower energies. 57 On the contrary, the CT values of Cit-Dy-CSS NPs displayed an initial increase in CT values when the voltage increased from 70 to 110 kV, followed by a decrease at 120 kV (Fig. S21B/C †).…”

CT colonography screening in extracolonic cancer survivors: impact on rates of colorectal and extracolonic findings by cancer type

“…[8] Oral contrast material tagging was achieved with 2.1% w/v barium sulfate and water-soluble iodinated contrast. [9] During the CTC examination, colorectal insufflation was maintained using room air or automated continuous low-pressure carbon dioxide delivered through a small flexible rectal catheter. [10] Patients were routinely scanned in both supine and prone positions, with additional decubitus positioning as needed.…”

CT Colonographic Screening of Patients With a Family History of Colorectal Cancer: Comparison With Adults at Average Risk and Implications for Guidelines

“…13 Oral contrast material tagging of residual fecal material was achieved with 2.1% weight/volume barium sulfate; fluid tagging was achieved with either diatrizoate or iohexol iodinated contrast medium. 14 During the CTC examination, colonic insufflation was maintained using room air or automated continuous low-pressure carbon dioxide delivered through a small flexible rectal catheter. 15 Patients were routinely scanned in both supine and prone positions, with additional decubitus positioning as needed.…”