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Abdominal and pelvic CT: is positive enteric contrast still necessary? Results of a retrospective observational study

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

Evaluation of diagnostic accuracy of abdominal CT depending on the type of enteric contrast agent.

Methods and materials

Multislice CTs of 2,008 patients with different types of oral preparation (positive with barium, n = 576; neutral with water, n = 716; and no enteric contrast, n = 716) were retrospectively evaluated by two radiologists including delineation of intestinal segments and influence on diagnosis and diagnostic reliability exerted by the enteric contrast, using a three-point scale. Furthermore, diagnostic reliability of the delineation of selected enteric pathologies was noted. CT data were assigned into groups: oncology, inflammation, vascular, pathology, trauma and gastrointestinal pathology.

Results

Delineation of the bowel was clearly practicable across all segments irrespective of the type of enteric contrast, though a slight impairment was observed without enteric contrast. Although delineation of intestinal pathologies was mostly classified “clearly delimitable” more difficulties occurred without oral contrast (neutral/positive/no contrast, 0.8 %/3.8 %/6.5 %). Compared to examinations without enteric contrast, there was a significant improvement in diagnosis that was even increased regarding the reader’s diagnostic reliability. Positive opacification impaired detection of mucosal enhancement or intestinal bleeding.

Conclusion

Water can replace positive enteric contrast agents in abdominal CTs. However, selected clinical questions require individual enteric contrast preparations. Pathology detection is noticeably impaired without any enteric contrast.

Key Points

• Neutral oral contrast ensures an equivalent delineation of the bowel.

• Neutral contrast ensures a similar detection rate for intestinal pathologies.

• Positive enteric contrast should be used in selected questions (suspected fistulas, abscesses).

• Detection of pathologies and bowel delineation proved more difficult without oral contrast.

• Diagnosis and the reporting physician’s diagnostic reliability are impaired without enteric contrast.

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Acknowledgments

The scientific guarantor of this publication is Boris Buerke. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was not required because the institutional review board proved it not to be necessary (document attached). Written informed consent was waived by the institutional review board. Methodology: retrospective, randomised controlled trial, performed at one institution.

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Authors and Affiliations

  1. Department of Clinical Radiology, University Hospital Münster, Münster, Germany

    S. Kammerer, A. J. Höink, J. Wessling, C. Schuelke, W. Heindel & B. Buerke

  2. Department of Gastroenterology and Metabolic Diseases, University Hospital Münster, Münster, Germany

    H. Heinzow

  3. Institute of Biostatistics and Clinical Research, University Muenster, Münster, Germany

    R. Koch

Authors
  1. S. Kammerer
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  2. A. J. Höink
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  3. J. Wessling
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  4. H. Heinzow
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  5. R. Koch
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  6. C. Schuelke
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  7. W. Heindel
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  8. B. Buerke
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Correspondence to S. Kammerer.

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Kammerer, S., Höink, A.J., Wessling, J. et al. Abdominal and pelvic CT: is positive enteric contrast still necessary? Results of a retrospective observational study. Eur Radiol 25, 669–678 (2015). https://doi.org/10.1007/s00330-014-3446-9

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  • DOI: https://doi.org/10.1007/s00330-014-3446-9

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