Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension

Ajaj, Waleed; Goehde, Susanne C.; Schneemann, Hubert; Ruehm, Stefan G.; Debatin, Jörg F.; Lauenstein, Thomas C.

doi:10.1007/s00330-003-2177-0

Cited by 80 publications

(11 citation statements)

References 34 publications

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“…1,4 However, our results indicate that there is no statistically significant difference between psyllium and sorbitol in both the quantitative (p 5 0.338-0.908) and qualitative (p 5 0.083-0.856) assessments of bowel distension. A similar profile of distension (Figures 3 and 4) was found for both OCAs in the five small bowel segments investigated with distension of the ileum favoured over the jejunum.…”

Section: Discussionmentioning

confidence: 58%

“…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%

“…The radiologists graded the distension of each bowel segment on a five-point scale as validated in previous studies: 0, very poor distension; 1, poor distension; 2, fair distension; 3, good distension; and 4, excellent distension. 1,2,7 In addition, the overall distension of the entire small bowel was graded on the same five-point scale.…”

Section: Image Analysismentioning

confidence: 99%

“…Combinations of highly osmolar agents and non-osmotic agents are also frequently used, as in the case of sorbitol and locust bean gum. 1,2 Ideally, 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 easy availability, (v) have easy storage and (vi) have no serious adverse side effects. 3 Currently, VoLumen® (E-Z-EM Inc., Westbury, NY), a biphasic OCA comprising 0.1% w/v ultra-low-dose barium with sorbitol, simethicone and natural gums, is commonly used for MRE examinations in the USA.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Image Analysismentioning

confidence: 99%

mentioning

confidence: 99%

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

Saini

Colak

Anthwal

et al. 2014

BJR

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“…Small bowel distension with an oral contrast agent improves accuracy of MRE compared with a non-prepared examination. 67 Many different oral contrast agents are described in the literature, 68,69,112,113 with no single preferred or recommended agent, 52 although there is evidence that distension quality is related to the osmolarity of the ingested agent. 70 In the METRIC study, recruitment sites used either mannitol (alone or with various additives) or polyethylene glycol.…”

Section: Influence Of Oral Contrast Agent and Ingested Volume On Smalmentioning

confidence: 99%

Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn’s disease patients: the METRIC diagnostic accuracy study

Taylor

Mallett

Bhatnagar

et al. 2019

Health Technol Assess

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Background Magnetic resonance enterography and enteric ultrasonography are used to image Crohn’s disease patients. Their diagnostic accuracy for presence, extent and activity of enteric Crohn’s disease was compared. Objective To compare diagnostic accuracy, observer variability, acceptability, diagnostic impact and cost-effectiveness of magnetic resonance enterography and ultrasonography in newly diagnosed or relapsing Crohn’s disease. Design Prospective multicentre cohort study. Setting Eight NHS hospitals. Participants Consecutive participants aged ≥ 16 years, newly diagnosed with Crohn’s disease or with established Crohn’s disease and suspected relapse. Interventions Magnetic resonance enterography and ultrasonography. Main outcome measures The primary outcome was per-participant sensitivity difference between magnetic resonance enterography and ultrasonography for small bowel Crohn’s disease extent. Secondary outcomes included sensitivity and specificity for small bowel Crohn’s disease and colonic Crohn’s disease extent, and sensitivity and specificity for small bowel Crohn’s disease and colonic Crohn’s disease presence; identification of active disease; interobserver variation; participant acceptability; diagnostic impact; and cost-effectiveness. Results Out of the 518 participants assessed, 335 entered the trial, with 51 excluded, giving a final cohort of 284 (133 and 151 in new diagnosis and suspected relapse cohorts, respectively). Across the whole cohort, for small bowel Crohn’s disease extent, magnetic resonance enterography sensitivity [80%, 95% confidence interval (CI) 72% to 86%] was significantly greater than ultrasonography sensitivity (70%, 95% CI 62% to 78%), with a 10% difference (95% CI 1% to 18%; p = 0.027). For small bowel Crohn’s disease extent, magnetic resonance enterography specificity (95%, 95% CI 85% to 98%) was significantly greater than ultrasonography specificity (81%, 95% CI 64% to 91%), with a 14% difference (95% CI 1% to 27%). For small bowel Crohn’s disease presence, magnetic resonance enterography sensitivity (97%, 95% CI 91% to 99%) was significantly greater than ultrasonography sensitivity (92%, 95% CI 84% to 96%), with a 5% difference (95% CI 1% to 9%). For small bowel Crohn’s disease presence, magnetic resonance enterography specificity was 96% (95% CI 86% to 99%) and ultrasonography specificity was 84% (95% CI 65% to 94%), with a 12% difference (95% CI 0% to 25%). Test sensitivities for small bowel Crohn’s disease presence and extent were similar in the two cohorts. For colonic Crohn’s disease presence in newly diagnosed participants, ultrasonography sensitivity (67%, 95% CI 49% to 81%) was significantly greater than magnetic resonance enterography sensitivity (47%, 95% CI 31% to 64%), with a 20% difference (95% CI 1% to 39%). For active small bowel Crohn’s disease, magnetic resonance enterography sensitivity (96%, 95% CI 92% to 99%) was significantly greater than ultrasonography sensitivity (90%, 95% CI 82% to 95%), with a 6% difference (95% CI 2% to 11%). There was some disagreement between readers for both tests. A total of 88% of participants rated magnetic resonance enterography as very or fairly acceptable, which is significantly lower than the percentage (99%) of participants who did so for ultrasonography. Therapeutic decisions based on magnetic resonance enterography alone and ultrasonography alone agreed with the final decision in 122 out of 158 (77%) cases and 124 out of 158 (78%) cases, respectively. There were no differences in costs or quality-adjusted life-years between tests. Limitations Magnetic resonance enterography and ultrasonography scans were interpreted by practitioners blinded to clinical data (but not participant cohort), which does not reflect use in clinical practice. Conclusions Magnetic resonance enterography has higher accuracy for detecting the presence, extent and activity of small bowel Crohn’s disease than ultrasonography does. Both tests have variable interobserver agreement and are broadly acceptable to participants, although ultrasonography produces less participant burden. Diagnostic impact and cost-effectiveness are similar. Recommendations for future work include investigation of the comparative utility of magnetic resonance enterography and ultrasonography for treatment response assessment and investigation of non-specific abdominal symptoms to confirm or refute Crohn’s disease. Trial registration Current Controlled Trials ISRCTN03982913. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 42. See the NIHR Journals Library website for further project information.

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Gastrointestinal tract

Martín¹,

Ramalho²,

Matos³

et al. 2015

Abdominal‐Pelvic MRI

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Oral contrast agents for small bowel MRI: comparison of different additives to optimize bowel distension

Cited by 80 publications

References 34 publications

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

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

Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn’s disease patients: the METRIC diagnostic accuracy study

Gastrointestinal tract

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