The Impact of Enteric Contrast on Radiologist Confidence in Intravenously Enhanced MDCT of the Abdomen and Pelvis: A Randomized Controlled Trial

Abstract

After Institutional Review Board approval, 109 patients ≥ 18 years old undergoing intravenously enhanced Computed Tomography (CT) of the abdomen and pelvis were prospectively enrolled and randomized into two arms. Patients with a history of inflammatory bowel disease, Crohn disease and ulcerative colitis were excluded. The control arm received routine enteric contrast and intravenous contrast. The experimental arm did not receive oral contrast, but received the standard dose of intravenous (IV) contrast. One of four experienced body radiologists reviewed the studies and rated his/her confidence on a scale of 1 (no confidence) to 10 (all confident findings have been made). Confidence levels were compared between groups. The 109 subjects were distributed 54 (49.5%) in the control arm and 55 (50.5%) in the experimental arm. The average confidence level in the control arm was 8.7 ± 0.9 versus 8.4 ± 1.1 in the experimental arm, which is not statistically significant (p value = 0.09). Among radiologists, the average confidence levels ranged from 6 -10 in the control arm and 7 -10 in the experimental arm. No examinations were repeated for technical considerations in either group. No studies were repeated in the experimental group in order to administer oral contrast. When each radiologist was compared to the others, there were no differences in confidence level between pairs in the control arm; however, there were statistically significant differences in confidence level among three pairs of radiologists for the experimental arm. There was no statistically significant difference in radiologist confidence level between intravenously enhanced abdomen and pelvis CTs with enteric contrast and without enteric contrast. C. M. Garcia et al.

A prospective study comparing water only with positive oral contrast in patients undergoing abdominal CT scan

“…However, it is not clear whether the advantages of withholding oral contrast in the emergency department can be extrapolated to the outpatient setting, as they have different clinical questions and patient spectrum. There are no sufficient data on withholding oral contrast in this patient population [6][7][8][9] and the available data are also equivocal. positive and negative oral contrast.…”