Peroral CT Enterography with Lactulose Solution: Preliminary Observations

Arslan, Halil; Etlik, Ömer; Kayan, Mustafa; Harman, Mustafa; Tuncer, Ýlyas; Temízöz, Osman

doi:10.2214/ajr.04.0466

Cited by 47 publications

(34 citation statements)

References 22 publications

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“…The results of our study are in accordance with previous investigators who demonstrated that bowel wall was visualized better with other neutral oral contrast agents, such as lactulose (16), mannitol (17,18), cellulose (19), methylcellulose (20), mucofalk diluted in water (Falk, Feiburg, Germany) (1, 21), and polyethylene glycol (2,22). Some of these solutions are widely used, particularly in Europe.…”

Section: Discussionsupporting

confidence: 92%

GI tract wall visualization and distension during abdominal and pelvic multidetector CT with a neutral barium sulphate suspension: comparison with positive barium sulphate suspension and with water

Oliva¹,

Ertürk²,

Ichikawa

et al. 2012

Journal of the Belgian Society of Radiology

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Objective: When examining patients with contrast-enhanced multidetector-row CT, we determined if the stomach and small bowel were visualized and distended better with a neutral barium sulphate suspension than with positive barium sulphate suspension or water. Materials and methods: After obtaining approval from our institutional review board, 156 patients (women: 84; mean age: 54 yrs) with no history of gastrointestinal tract disease were randomized prospectively to receive orally either 900 ml of neutral (0.1%w/v) barium sulphate suspension (n = 53), 900 ml of positive (2.1%w/v) barium sulphate suspension (n = 53), or 900 ml of water (n = 50), prior to undergoing contrast-enhanced abdominal and pelvic multidetector-row CT. Two independent radiologists evaluated the stomach, and small bowel, for luminal distension and wall visualization, using a five point scale. Results were compared using Kruskal-Wallis and Mann-Whitney U tests. Results: The walls of the stomach, and small bowel were visualized better in patients who were administered neutral barium sulphate suspension than those who were administered either positive barium sulphate suspension (p < 0.01) or water (p < 0.01). In patients who received neutral barium sulphate suspension, the stomach and small bowel were distended better compared to patients administered water (p < 0.01); the stomach, duodenum, and ileum were distended better compared to patients administered positive barium sulphate suspension (p < 0.05). Conclusions: When examining patients with intravenous contrast-enhanced abdominal and pelvic multidetector-row CT, orally administered neutral barium sulphate suspension allows the gastrointestinal tract to be visualized and distended better than either positive barium sulphate suspension, or water.

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Section: Discussionsupporting

confidence: 92%

GI tract wall visualization and distension during abdominal and pelvic multidetector CT with a neutral barium sulphate suspension: comparison with positive barium sulphate suspension and with water

Oliva¹,

Ertürk²,

Ichikawa

et al. 2012

Journal of the Belgian Society of Radiology

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“…Neutral or low-density oral contrast media are a prerequisite for good-quality CT enterography [3][4][5] because they maximise contrast between the lumen and enhancing small bowel wall, facilitating assessment of mucosal thickening and wall stratification/enhancement patterns [1][2][3][4][5][6][7][8]. Water-methylcellulose solution, polyethylene glycol, commercially available low-density barium, 0.1% Volumen (Bracco, Milan, Italy) and milk are examples of neutral oral contrast agents with CT attenuation properties similar to that of water.…”

Section: Luminal Contrast and Distensionmentioning

confidence: 99%

CT enterography: review of technique and practical tips

Ilangovan¹,

Burling²,

George³

et al. 2012

BJR

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ABSTRACT. CT enterography is a new non-invasive imaging technique that offers superior small bowel visualisation compared with standard abdomino-pelvic CT, and provides complementary diagnostic information to capsule endoscopy and MRI enterography. CT enterography is well tolerated by patients and enables accurate, efficient assessment of pathology arising from the small bowel wall or surrounding organs. This article reviews the clinical role of CT enterography, and offers practical tips for optimising technique and accurate interpretation. Until recently, diagnosis of small bowel pathology had relied primarily on radiological techniques, in part due to the relative inaccessibility of the small bowel to conventional endoscopy. However, new endoscopic developments-notably the recent introduction of capsule endoscopy and double balloon enteroscopy-are challenging this position. Capsule endoscopy, for example, is now generally accepted as first-line investigation for occult gastrointestinal haemorrhage, and increasingly advocated for diagnosis of early Crohn's disease. However, the radiological community has not stood still. In parallel with the development of new endoscopic techniques, rapid progress has been made in crosssectional imaging technologies, harnessing the power of multidetector row CT (MDCT), MRI and ultrasound, facilitating rapid, accurate and minimally invasive investigation of the small bowel and adjacent tissues.CT enterography was first introduced by Raptopoulos et al [1] in 1997 as a modification to ''standard'' abdomino-pelvic CT examination to specifically examine the small bowel in detail, notably to assess the extent and severity of Crohn's disease [1,2]. They combined neutral (low-density) oral contrast with ''enteric phase'' CT to optimise contrast resolution between mucosa and lumen, thereby maximising conspicuity of abnormalities arising from the small bowel wall. Several authors have subsequently described similar techniques, which are broadly categorised into CT enterography (where patients drink oral contrast) and CT enteroclysis (luminal contrast is introduced via a nasojejunal tube placed fluoroscopically prior to CT examination). Although superior jejunal distension is attained using enteroclysis, the convenience, efficiency and superior patient experience achieved with CT enterography make it the preferred technique at the authors' institutions, and therefore the focus of this review. This paper will critically review the CT enterography technique and provide practical tips on interpretation to assist radiologists and help them avoid common interpretative pitfalls. We will also examine its role relative to other complementary non-ionising radiation radiological tests. TechniqueThe technique of CT enterography combines small bowel distension with a neutral or low-density oral contrast mixture and abdomino-pelvic CT examination during the enteric phase following administration of intravenous contrast. Patients drink approximately 1.5-2 l of oral contrast over 45-60 min. Patient comp...

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“…For the CT enterography portion of the study, a large volume of bowel-distending negative contrast material was administered (13). A 1,250-mL volume of the solution, which comprised 1,000 mL of water and 250 mL of lactulose (670 mg/mL) (Laevolac; Fresenius-Kabi), was ingested orally over 40-50 min at a steady rate.…”

Section: F-fdg Pet/ct Enterography Scansmentioning

confidence: 99%

PET/CT Enterography in Crohn Disease: Correlation of Disease Activity on CT Enterography with ¹⁸F-FDG Uptake

Groshar¹,

Bernstine²,

Stern³

et al. 2010

J Nucl Med

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We combined 18 F-FDG PET and CT enterography in a single examination and compared the level of 18 F-FDG uptake measured by maximal standardized uptake value (SUVmax) with the CT enterography patterns of disease activity found in patients with Crohn disease (CD). Methods: Twenty-eight patients (mean age, 37.5 y; 11 male and 17 female) suspected of having active CD underwent PET/CT enterography. Abnormal bowel segments recognized on CT enterography were graded qualitatively for the presence of perienteric fat infiltration, the comb sign, and intramural attenuation and by quantitative measurements of mural enhancement (Hounsfield units) and thickness (mm). Also, for each patient, normal segments of the ileum and colon were noted, and CT enterography measurements of thickness and enhancement were obtained. For segments detected on CT enterography, a volume of interest was placed on the fused 18 F-FDG PET scan, and the SUVmax was obtained. Results: Of the 28 patients with suspected active CD, 22 had 85 abnormal segments and 6 had no abnormal segments. SUVmax was significantly higher in the abnormal segments than in the normal segments (5.0 6 2.5 [95% confidence interval, 4.5-5.5] and 2.1 6 0.69 [95% confidence interval, 1.9-2.2], respectively; P , 0.0001). A good correlation was found between SUVmax with CT enterography measurements of mural thickness and enhancement (P , 0.00001). There was a significant difference in SUVmax between the 3 levels of disease activity found by intramural attenuation, perienteric fat infiltration, and the comb sign on CT enterography. SUVmax was significantly higher when there were intense CT enterography findings of active disease (P , 0.001). Conclusion: SUVmax assessment may allow an objective, reliable indication of the grade and severity of inflammation activity in abnormal segments of the bowel detected by CT enterography.

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Peroral CT Enterography with Lactulose Solution: Preliminary Observations

Cited by 47 publications

References 22 publications

GI tract wall visualization and distension during abdominal and pelvic multidetector CT with a neutral barium sulphate suspension: comparison with positive barium sulphate suspension and with water

GI tract wall visualization and distension during abdominal and pelvic multidetector CT with a neutral barium sulphate suspension: comparison with positive barium sulphate suspension and with water

CT enterography: review of technique and practical tips

PET/CT Enterography in Crohn Disease: Correlation of Disease Activity on CT Enterography with ¹⁸F-FDG Uptake

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Peroral CT Enterography with Lactulose Solution: Preliminary Observations

Cited by 47 publications

References 22 publications

GI tract wall visualization and distension during abdominal and pelvic multidetector CT with a neutral barium sulphate suspension: comparison with positive barium sulphate suspension and with water

GI tract wall visualization and distension during abdominal and pelvic multidetector CT with a neutral barium sulphate suspension: comparison with positive barium sulphate suspension and with water

CT enterography: review of technique and practical tips

PET/CT Enterography in Crohn Disease: Correlation of Disease Activity on CT Enterography with 18F-FDG Uptake

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PET/CT Enterography in Crohn Disease: Correlation of Disease Activity on CT Enterography with ¹⁸F-FDG Uptake