Abstract
Purpose
To objectively compare residual colonic fluid volume and attenuation of oral sulfate solution (OSS) with four different established cathartic regimens using an automated volumetric software tool at CT colonography (CTC).
Methods
This HIPAA-compliant study had institutional review board approval. Volumetric analysis of residual contrast-tagged colonic fluid was performed on CTC studies in 263 adults (mean age 60.1 years; 137M/126F) using an automated volumetric software tool. Twenty-three patients receiving 177 mL OSS (SUPREP; single-bottle purgation) were compared with 60 patients each receiving 45 mL sodium phosphate (NaP), 90 mL NaP (2× NaP), 592 mL (two bottles) magnesium citrate (MgC), and 4,000 mL polyethylene glycol (PEG). All patients received oral contrast cleansing after catharsis. Data were analyzed with unpaired t test with Welch correction and F test.
Results
The mean volume of residual colonic fluid was less with OSS (125 ± 60 mL) than for established cathartic agents: 2× NaP (206 ± 125 mL, P < 0.0001), MgC (184 ± 125 mL, P < 0.01), PEG (166 ± 114 mL, P < 0.05), and NaP (165 ± 135 mL, P = 0.067). Variance of volumes was also significantly lower for OSS (range 28–251 mL) than for established agents (range 4–853 mL) (all P < 0.01). Mean fluid attenuation was higher with OSS (956 ± 168 HU) than for established agents (all P < 0.05): 2× NaP (455 ± 191 HU), MgC (691 ± 154 HU), NaP (779 ± 127 HU), and PEG (843 ± 193 HU).
Conclusions
Automated volumetry allows rapid objective assessment of bowel preparation quality at CTC. Purgation with the novel oral sulfate solution (SUPREP) consistently resulted in less residual colonic fluid and higher fluid attenuation compared with established cathartic regimens.
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References
Kim DH, Pickhardt PJ, Taylor AJ, et al. (2007) CT colonography versus colonoscopy for the detection of advanced neoplasia. N Engl J Med 357(14):1403–1412
Pickhardt PJ, Hassan C, Laghi A, et al. (2007) Cost-effectiveness of colorectal cancer screening with computed tomography colonography—the impact of not reporting diminutive lesions. Cancer 109(11):2213–2221
Hassan C, Pickhardt P, Laghi A, et al. (2008) Computed tomographic colonography to screen for colorectal cancer, extracolonic cancer, and aortic aneurysm. Arch Intern Med 168(7):696–705
Pickhardt PJ, Choi JR, Hwang I, et al. (2003) Computed tomographic virtual colonoscopy to screen for colorectal neoplasia in asymptomatic adults. N Engl J Med 349(23):2191–2200
Johnson CD, Chen MH, Toledano AY, et al. (2008) Accuracy of CT colonography for detection of large adenomas and cancers. N Engl J Med 359(12):1207–1217
Seeff LC, Manninen DL, Dong FB, et al. (2004) Is there endoscopic capacity to provide colorectal cancer screening to the unscreened population in the United States? Gastroenterology 127(6):1661–1669
Schwartz DC, Dasher KJ, Said A, et al. (2008) Impact of a CT colonography screening program on endoscopic colonoscopy in clinical practice. Am J Gastroenterol 103:346–351. doi:10.1111/j.1572-0241.2007.01586.x
Pickhardt PJ (2013) Computed tomography colonography: emerging evidence to further support clinical effectiveness. Curr Opin Gastroenterol 29(1):55–59. doi:10.1097/MOG.0b013e32835a3480
Shapiro JA, Seeff LC, Thompson TD, et al. (2008) Colorectal cancer test use from the 2005 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev 17(7):1623–1630. doi:10.1158/1055-9965.EPI-07-2838
Force USPST (2008) Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 149(9):627–637
Maciosek MV, Solberg LI, Coffield AB, Edwards NM, Goodman MJ (2006) Colorectal cancer screening: health impact and cost effectiveness. Am J Prev Med 31(1):80–89. doi:10.1016/j.amepre.2006.03.009
Harewood GC, Wiersema MJ, Melton LJ 3rd (2002) A prospective, controlled assessment of factors influencing acceptance of screening colonoscopy. Am J Gastroenterol 97(12):3186–3194. doi:10.1111/j.1572-0241.2002.07129.x
Beebe TJ, Johnson CD, Stoner SM, Anderson KJ, Limburg PJ (2007) Assessing attitudes toward laxative preparation in colorectal cancer screening and effects on future testing: potential receptivity to computed tomographic colonography. Mayo Clin Proc 82(6):666–671. doi:10.4065/82.6.666
Pickhardt PJ (2007) Colonic preparation for computed tomographic colonography: understanding the relative advantages and disadvantages of a noncathartic approach. Mayo Clin Proc 82(6):659–661
Pickhardt PJ, Kim DH (2010) CT colonography: principles and practice of virtual colonoscopy. Philadelphia: Saunders
Kim DH, Pickhardt PJ, Hinshaw JL, et al. (2007) Prospective blinded trial comparing 45-mL and 90-mL doses of oral sodium phosphate for bowel preparation before computed tomographic colonography. J Comput Assist Tomogr 31(1):53–58
Berkelhammer C, Ekambaram A, Silva RG (2002) Low-volume oral colonoscopy bowel preparation: sodium phosphate and magnesium citrate. Gastrointest Endosc 56(1):89–94
Markowitz GS, Stokes MB, Radhakrishnan J, D’Agati VD (2005) Acute phosphate nephropathy following oral sodium phosphate bowel purgative: an underrecognized cause of chronic renal failure. J Am Soc Nephrol 16(11):3389–3396
Borden ZS, Pickhardt PJ, Kim DH, et al. (2010) Bowel preparation for CT colonography: blinded comparison of magnesium citrate and sodium phosphate for catharsis. Radiology 254(1):138–144
Macari M, Lavelle M, Pedrosa I, et al. (2001) Effect of different bowel preparations on residual fluid at CT colonography. Radiology 218(1):274–277
Vanner SJ, MacDonald PH, Paterson WG, et al. (1990) A randomized prospective trial comparing oral sodium phosphate with standard polyethylene glycol-based lavage solution (Golytely) in the preparation of patients for colonoscopy. Am J Gastroenterol 85(4):422–427
Di Palma JA, Rodriguez R, McGowan J, Cleveland M (2009) A randomized clinical study evaluating the safety and efficacy of a new, reduced-volume, oral sulfate colon-cleansing preparation for colonoscopy. Am J Gastroenterol 104(9):2275–2284. doi:10.1038/ajg.2009.389
Rex DK, Di Palma JA, Rodriguez R, McGowan J, Cleveland M (2010) A randomized clinical study comparing reduced-volume oral sulfate solution with standard 4-liter sulfate-free electrolyte lavage solution as preparation for colonoscopy. Gastrointest Endosc 72(2):328–336. doi:10.1016/j.gie.2010.03.1054
Cohen SM, Wexner SD, Binderow SR, et al. (1994) Prospective, randomized, endoscopic-blinded trial comparing precolonoscopy bowel cleansing methods. Dis Colon Rectum 37(7):689–696
Pickhardt PJ (2007) Screening CT colonography: how I do it. AJR Am J Roentgenol 189(2):290–298
Pickhardt PJ, Choi JHR (2003) Electronic cleansing and stool tagging in CT colonography: advantages and pitfalls with primary three-dimensional evaluation. Am J Roentgenol 181(3):799–805
Slater A, Taylor SA, Burling D, et al. (2006) Colonic polyps: effect of attenuation of tagged fluid and viewing window on conspicuity and measurement—in vitro experiment with porcine colonic specimen. Radiology 240(1):101–109. doi:10.1148/radiol.2401050984
Deshpande KK, Summers RM, Van Uitert RL, et al. (2007) Quality assessment for CT colonography: validation of automated measurement of colonic distention and residual fluid. Am J Roentgenol 189(6):1457–1463
Van Uitert RL, Summers RM, White JM, et al. (2008) Temporal and multiinstitutional quality assessment of CT colonography. AJR Am J Roentgenol 191(5):1503–1508
Hung PW, Paik DS, Napel S, et al. (2002) Quantification of distention in CT colonography: development and validation of three computer algorithms. Radiology 222(2):543–554. doi:10.1148/radiol.2222010600
Park SH, Ha HK, Kim MJ, et al. (2005) False-negative results at multi-detector row CT colonography: multivariate analysis of causes for missed lesions. Radiology 235(2):495–502
Pickhardt PJ, Kim DH (2013) CT Colonography: pitfalls in Interpretation. Radiol Clin N Am 51(1):69–88. doi:10.1016/j.rcl.2012.09.005
Acknowledgments
This research was supported in part by the National Institutes of Health NCI Grants 1R01CA144835-01 and 1R01CA169331-01.
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Bannas, P., Bakke, J., Patrick, J.L. et al. Automated volumetric analysis for comparison of oral sulfate solution (SUPREP) with established cathartic agents at CT colonography. Abdom Imaging 40, 11–18 (2015). https://doi.org/10.1007/s00261-014-0186-x
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DOI: https://doi.org/10.1007/s00261-014-0186-x