Radiology of the Colon

Scott-Harden, W. G.; Philp, Lauren; Moule, Brian

doi:10.1259/0007-1285-40-469-15

Cited by 12 publications

(2 citation statements)

References 5 publications

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“…The data may have been more favorable for air‐distention if carbon dioxide (CO 2 ) would have been used. Albeit somewhat more expensive than room air, the accelerated absorption from the gastrointestinal tract has favored CO 2 as the optimal gaseous agent for colonic imaging as it results in less discomfort (27, 28). From an imaging point of view, air and CO 2 seem to be interchangeable (7).…”

Section: Discussionmentioning

confidence: 99%

MR colonography: How does air compare to water for colonic distention?

Ajaj¹,

Lauenstein²,

Pelster³

et al. 2004

Magnetic Resonance Imaging

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Purpose:To prove the feasibility of air-distended magnetic resonance colonography (MRC) and compare it with waterbased distention. Materials and Methods:In five volunteers, the colon was imaged twice: once after distending the colon with air and a second time after distending the colon with water. A total of 50 patients, who had been referred to colonoscopy for a suspected colorectal pathology were randomized into water-distention (N ϭ 25) and air-distention (N ϭ 25) groups. A contrast-enhanced T1-weighted three-dimensional volume interpolated breath-hold (VIBE) sequence was collected. Comparative analysis was based on qualitative ratings of image quality and bowel distention, as well as contrast-to-noise ratio (CNR) measurements for the colonic wall with respect to the colonic lumen. In addition, patient acceptance was evaluated.Results: Inflammatory changes and colorectal masses were correctly identified on MRC in eight patients each. One 4-mm polyp identified at colonoscopy was missed on waterdistended MRC. There were no false positive findings. No significant differences were found between air-and waterdistention regarding discomfort levels and image quality. The presence of air in the colonic lumen was not associated with susceptibility artifacts. CNR of the contrast-enhanced colonic wall, as well as bowel distention, were superior on air-distended three-dimensional data sets. Conclusion:MRC can be performed using either water or air for colonic distention. Both techniques permit assessment of the colonic wall and identification of colorectal masses. While discomfort levels are similar for both agents, MRC with air provides higher CNR and better colonic distention. MAGNETIC RESONANCE (MR) colonography (MRC) has been shown to be an appropriate diagnostic tool for the detection of pathologies, including colorectal masses, diverticula, and inflammatory disease (1-4). Reliable assessment of the colon by means of MR imaging is predicated upon the fulfillment of two requirements: sufficient distention of the colonic lumen and sufficient contrast between the colonic lumen and pathologies arising from the colonic wall. Hence, the cleansed colon is filled either with liquid, such as tap water, with or without the addition of paramagnetic contrast (2,5,6), or gaseous agents, such as room air, CO 2 , and hyperpolarized helium (7-9). While initial experience was based on techniques rendering the colonic lumen bright, dark lumen MRC has recently been found to be advantageous (1,3).The fear of compromised image quality due to susceptibility effects at air/tissue interfaces has long favored the use of water or water-based solutions for colonic distention in MRC (6,10). With the availability of high performance gradients permitting data acquisition with very short echo times, the potential of relevant susceptibility effects is reduced. Accordingly, interest in the use of gaseous agents has grown. They avoid the risk of spillage and have been suggested to be associated with less discomfort compared to fluid (7,8).The purpos...

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Section: Discussionmentioning

confidence: 99%

MR colonography: How does air compare to water for colonic distention?

Ajaj¹,

Lauenstein²,

Pelster³

et al. 2004

Magnetic Resonance Imaging

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“…This pain may be delayed some hours until any smooth muscle relaxant given wears off. Several studies have recommended using carbon dioxide (CO 2 ) as an alternative to air as it is absorbed more rapidly from the gastrointestinal tract and causes less pain [1,2]. Benefit may not be immediately apparent [3], but post-DCBE pain is significantly reduced by using CO 2 …”

Section: Introductionmentioning

confidence: 99%

A comparison of air, CO2 and an air/CO2 mixture as insufflation agents for double contrast barium enema*

et al. 1998

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Using CO2 for DCBE is recommended as it may decrease pain afterwards but recent studies suggest it produces inferior distension. This prospective double blind study was designed to evaluate the use of an air/CO2 mixture. We randomised 105 patients to receive air, CO2 or a 50/50 mixture as the insufflation agent in DCBE. Gases were administered from prefilled bags. Those requiring additional insufflations before over couch films were recorded. Post procedure symptoms were evaluated by questionnaire. Distension and mucosal coating were assessed independently. There was no difference in mucosal coating. Those given CO2 had significantly less immediate and delayed pain compared to air and less delayed pain compared to the 50/50 mixture. Distension with air was graded better than with the other two agents but the difference did not reach statistical significance. However 50 % of patients receiving CO2 and 40 % of those receiving the mixture required additional insufflation before over couch films as distension was considered suboptimal, compared to 17 % of those given air, which was statistically significant. Our results indicate that using CO2 causes less pain than using air or the mixture although top up insufflations are often required to maintain adequate quality distension.

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The single phase double contrast enema. A technique suitable for the average department

ApSimon

1970

Clinical Radiology

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Radiology of the Colon

Cited by 12 publications

References 5 publications

MR colonography: How does air compare to water for colonic distention?

MR colonography: How does air compare to water for colonic distention?

A comparison of air, CO2 and an air/CO2 mixture as insufflation agents for double contrast barium enema*

The single phase double contrast enema. A technique suitable for the average department

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