Comparison of oral iodine-131-cellulose and indium-111-DTPA as tracers for colon transit scintigraphy: analysis by colon activity profiles

In 11 normal subjects and 11 patients with a clinical diagnosis of constipation, oral 131I-cellulose and 111In-DTPA were compared simultaneously as tracers for radionuclide colon transit scintigraphy. Visual assessment of the images revealed no differences between tracers. Quantitation was performed using total and segmental percent retention and the derived value of clearance half-time. In addition, profiles of the activity distribution along the length of the colon were generated and the mean position of the activity in the colon calculated. For all indices, the results were similar in both normal subjects and constipated patients when comparing tracers, although marked differences were present between normal subjects and constipated patients for each tracer. Indium-111-DTPA was easy to administer and dosimetry was more acceptable than for 131I-cellulose, especially in constipated patients. It is concluded that 111In-DTPA is the preferred tracer for oral colon transit scintigraphy.     

Colon transit scintigraphy in health and constipation using oral iodine-131-cellulose

The purpose of the study was to assess if a new scintigraphic method for noninvasive assessment of colonic transit could differentiate between subjects with normal bowel transit and those with constipation. Eleven normal subjects and 29 constipated patients were given 4 MBq iodine-131-cellulose (131I-cellulose) orally and sequential abdominal scans were performed at 6, 24, 48, 72, and 96 hr from which total and segmental percent retentions were calculated. There were clear differences between the normal subjects and the constipated patients for the total percent retention at all time intervals, on a segmental basis in the right colon at 24 hr, and in all segments at 48 and 72 hr. Three-day urinary excretion of radioiodine was minimal; 2.4% +/- 1.2% (mean +/- s.d.) in constipated patients and 3.1% +/- 0.8% in normals, with approximately 75% occurring in the first day. The use of oral radiotracers in the investigation of constipation appears promising.     

CT colonography features of sigmoid diverticular disease

OBJECTIVE: The objective of this study is to assess the sigmoid distensibility during CT colonography (CTC) in patients with diverticular disease. METHODS: Consecutive patients without a history of pelvic radiation or neoplasms underwent 150 CTC. Three radiologists in consensus evaluated axial images for colonic distention, luminal diameters (mm), diverticula, and muscular thickening. RESULTS: The minimum colon diameter in patients with muscular thickening was significantly smaller, irrespective of the presence of diverticula (P=.009). CONCLUSION: Muscular thickening with diverticular disease was associated with significantly less sigmoid colon distension.     

Relationship between Gastrointestinal F-18-fluorodeoxyglucose Accumulation and Gastrointestinal Symptoms in Whole-Body PET

The pattern and intensity of F-18-FDG uptake in the gastrointestinal (GI) tract are variable and can often cause confusion. The purpose of this study was to evaluate the relationship between GI tract symptoms and GI uptake of F-18-FDG. We evaluated whole-body FDG-PET of 314 persons (M:F = 147:167; 13-83 years) in whom pathologic GI tract disorders had not been observed. Uptake score and pattern were evaluated visually. Symptoms were grouped as follows: diarrhea, constipation, and neither diarrhea nor constipation. Among symptom groups, there was no statistically significant difference in FDG uptake score. But intense FDG uptake with focal pattern, which can cause confusion, was observed more frequently in the descending colon of patients with constipation than in those with diarrhea or without GI symptoms. When focal intense FDG uptake is observed in the abdomino-pelvic area, stricter attention to GI symptoms would improve the specificity of whole-body FDG-PET.     

CT colonography versus colonoscopy in the follow-up of patients after diverticulitis - a prospective, comparative study

AIM: To assess whether computed tomography colonography (CTC) is a viable alternative to colonoscopy or double contrast barium enema in the follow-up of patients after diverticulitis. MATERIAL AND METHODS: Fifty patients underwent CTC followed immediately by colonoscopy. Results were blinded to the examiners. Findings of diverticular disease and patient acceptance were evaluated. RESULTS: Bowel preparation and distension were good in the majority of CTC and colonoscopy examinations. Diverticular disease was found in 96% of patients at CTC and in 90% at colonoscopy. The rate of agreement between CTC and colonoscopy for diverticular findings in the sigmoid colon was good (kappa=0.64). No complications were seen. Patients found colonoscopy more uncomfortable (p<0.03), more painful (p<0.001), and more difficult (p<0.01) than CTC. Of the patients favouring one examination, 74% preferred CTC. CONCLUSION: CTC appears to have a better diagnostic potential for imaging of diverticular disease-specific findings, when compared with colonoscopy. Also, CTC was less uncomfortable and was preferred by a majority of patients. CTC seems to be a reasonable alternative in follow-up of patients with symptomatic diverticular disease.     

Segmental colonic transit after oral 67Ga-citrate in healthy subjects and those with chronic idiopathic constipation.

Measurement of segmental colonic transit is important in the assessment of patients with severe constipation. 111In-diethylenetriamine pentaacetic acid (DTPA) has been established as the tracer of choice for these studies, but it is expensive and not readily available. 67Ga-citrate is an inexpensive tracer and when given orally is not absorbed from the bowel. It was compared with 111In-DTPA in colonic transit studies in nonconstipated control subjects and then in patients with idiopathic constipation. METHODS: Studies were performed after oral administration of 3 MBq (81 microCi) 67Ga-citrate or 4 MBq (108 microCi) 111In-DTPA in solution. Serial abdominal images were performed up to 96 h postinjection, and computer data were generated from geometric mean images of segmental retention of tracer, mean activity profiles and a colonic tracer half-clearance time. RESULTS: There were no differences in segmental retention of either tracer or in mean activity profiles between control subjects and constipated patients. Results in constipated subjects were significantly different from those in controls. The mean half-clearance times of tracer for control subjects were 28.8 h for 67Ga-citrate and 29.9 h for 111In-DTPA in control subjects and 75.0 h for 67Ga-citrate and 70.8 h for 111In-DTPA in constipated patients. CONCLUSION: Oral 67Ga-citrate can be used as a safe alternative to 111In-DTPA for accurate measurement of segmental colonic transit.     

Assessment of chronic constipation: colon transit time versus defecography

OBJECTIVE: The aim of this study was to determine the value of radiological colon transit time (CTT) measurements in relation to defecography (DFG) in chronically constipated patients. MATERIALS AND METHODS: In 30 patients with chronic constipation, total and segmental CTT was determined using radiopaque markers. In all of these patients defecography (DFG) was obtained. The patients were divided into three groups: In group I, 11 patients were classified with idiopathic constipation based on low stool frequency, normal DFG, or absence of symptoms of abnormal defecation. In group II, ten patients with rectal intussusception were diagnosed by DFG. In group III, there were nine patients with rectal prolapse or spastic pelvic floor syndrome, based on results of DFG. RESULTS: Group I, idiopathic constipation (n = 11), showed increased total CTT (mean, 93 h) and segmental CTT (right colon, 33 h (36%), left colon, 31 h (33%), rectosigmoid, 29 h (31%)). In group II, intussusception (n = 10), patients had normal mean total CTT (54 h) and a relative decrease in rectosigmoid CTT (mean, 13 h (24%)). In group III (n =9), rectal prolapse (n = 5) or spastic pelvic floor syndrome (n = 4), patients showed elevated total (mean, 167 h) and rectosigmoidal CTT (mean, 95 h (57%)). Mean total CTT was significantly different between groups I and II and between groups II and III, and mean rectosigmoidal CTT was significantly different between all three groups (P < 0.05). CONCLUSION: The use of total and rectosigmoidal CTT helps to identify the underlying pathophysiology of chronic constipation. Furthermore CTT helps to identify patients, who may benefit from DFG.     

北京某高校女大学生便秘相关因素分析

目的：了解北航女大学生对便秘相关知识的认知情况,分析导致北航女大学生便秘的相关因素,为进行健康教育提供资料。方法：随机抽取我校女大学生96名。使用自编的便秘相关知识认知问卷进行调查。结果：调查的150例女大学中便秘67例,便秘发生率44.67%。其中便秘的发生与不定时排使、经常抑制便意、运动量少、焦虑、情绪改变等有关,有显著性差异（P〈0.05）。结论：女大学生对便秘的认知不足,便秘发生率高。引起便秘的主要相关因素是饮水量少、不定时进餐、运动少、抑制便意、节食、睡眠差、熬夜、既往胃肠道史、焦虑等。因此,有必要在女大学生中进行针对性的健康教育,防止便秘的发生,以减少并发症,提高生活质量。     

Diverticular disease (adenomyomatosis) of the gallbladder: a radiological-pathological survey

Seventy consecutive gallbladders removed at surgery were examined radiologically and pathologically. Fifteen (21%) of the operative specimens showed naked-eye changes of adenomyomatosis. The main conclusions drawn from this study are that this abnormality is present in a much higher proportion of gallbladders removed at surgery than is generally realised, and that the pathogenesis is primarily an abnormality of muscle contractions, with a strong similarity to diverticular disease of the colon. Diverticular disease of the gallbladder might well be the most appropriate name for this condition. The results of a post-operative clinical assessment of patients with diverticular disease are also presented. But this represents a small number of patients and larger, perhaps multicentre, surveys would be required in order to assess the clinical significance of this interesting abnormality.     

Radiological and instrumental study of the colon in idiopathic constipation

It has been demonstrated that it is not always possible to attribute to constipation a reduced colonic transit time as being evidenced by radiological studies using radiopaque markers. In fact, in constipated patients with a normal transit time, it was more reasonable to consider a recto-anal disorder as evidenced by defecography and manometry.     

双核素结肠显像检测结肠运动功能

目的 建立一种新的、无创性的放射性核素定量检测结肠运动功能的方法。方法 正常对照者３２例,便秘患者２４例。将Ｎａ＾１３１Ｉ密封于在胃肠道内不被消化吸收的聚氯乙烯胶囊内,受检者同时口服Ｎａ＾１３１Ｉ胶囊及＾９９Ｔｃ－硫胶体,然后定时静态双核素采集,并计算图形中心（ＧＣ）值。结果 （１）＾９９Ｔｃ－硫胶体能清晰显示结肠轮廓,对Ｎａ＾１３１Ｉ胶囊进行准确体内定位;（２）正常对照组其口盲,结肠及全胃肠道通     

Vertebroplasty for osteoporotic fractures with spinal canal compromise

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty can aggravate spinal canal narrowing, especially in patients with preoperative retropulsion. The purpose of this study was to evaluate changes in spinal canal dimension during percutaneous vertebroplasty for osteoporotic fractures with retropulsion. MATERIALS AND METHODS: We reviewed all cases of osteoporotic vertebral fractures treated with vertebroplasty. Twenty-one patients (25 vertebrae) had a retropulsed fragment that compromised the dimension of the spinal canal on preoperative imaging. We measured the degree of retropulsion before and after vertebroplasty to evaluate changes in spinal canal dimension. We also evaluated pain, neurologic status, vertebral body height, and wedge angle. RESULTS: Mean retropulsion was 4.2 mm before and 4.4 mm after vertebroplasty. There was no statistically significant difference (P = .32). Mean increase in vertebral body height was 2.6 mm anteriorly, 1.7 mm centrally, and 0.3 mm posteriorly. Mean decrease in wedge angle was 4.7 degrees. There were statistically significant improvements in height and wedge angle (P < .01). None of our patients developed new symptoms during vertebroplasty or thereafter. Twenty of 21 patients (95%) showed partial or complete immediate pain relief, whereas 1 patient did not improve. CONCLUSION: Vertebroplasty can be performed safely in patients with spinal canal compromise. This procedure can reduce pain, increase vertebral body height, and decrease wedge angle without worsening of retropulsion.     

Diverticular disease of the colon

The great significance of diverticular disease, clinical symptoms, and pathologic-anatomical changes are demonstrated. In our opinion the diagnostic possibilities of a carefully performed hypotonic enema with double contrast are not yet fully used; mostly the patients have to suffer from an endoscopic investigation of the colon. Radiologic double-contrast examination is the method of choice, resulting in reliable and clear pictures of the extent of diverticulosis and in most cases also of its complications. Some typical examples are given to point out radiological criteria of the diverticular disease.     

钡剂结肠运输试验及其与标记物检查的初步对照研究

目的 探索用钡剂替代标记物进行结肠运输试验的检查方法. 资料与方法 运用结肠运输试验观察正常人和便秘患者的结肠运输情况,分别计算结肠24、48、72小时钡剂及不透光X线标记物的排空率. 结果 正常组72小时均排出80%或以上的钡剂,慢传输型便秘(slow transit constipation,STC)患者组72小时均未排出80%的钡剂,同一便秘患者短期内标记物与钡剂的排空率无显著差异. 结论 硫酸钡可替代标记物进行结肠运输试验的检查.     

Efficacy of IV Buscopan as a muscle relaxant in CT colonography

The aim of this study was to examine the efficacy of IV Buscopan as a muscle relaxant in CT colonography in terms of colonic distension and polyp detection, and to determine its particular efficacy in patients with diverticular disease. Seventy-three consecutive patients were randomised to receive IV Buscopan or no muscle relaxant prior to CT colonography. CT colonography was performed using a Siemens Somatom 4-detector multislice CT scanner. The following parameters were recorded: degree of colonic distension using a 4-point scale; diagnostic adequacy of colonic distension; presence or absence of diverticular disease; and presence of colonic polyps. Accuracy of polyp detection was assessed using subsequent conventional colonoscopy as a gold standard. There was no significant difference between the two groups in the number of segments that were deemed to be optimally or adequately distended (p=0.37). Although IV Buscopan did improve distension of certain segments, this effect was not sufficient to improve the number of diagnostically adequate studies in the Buscopan group (p=0.14). In patients with diverticular disease, IV Buscopan did not have any significant effect on segments affected by diverticulosis but was associated with an improvement in distension of more proximal segments. There was no significant difference between the two groups in terms of polyp detection (p=0.34). The addition of prone scanning to supine scanning was found to be the most useful technique for maximising colonic distension. Intravenous Buscopan at CT colonography does not improve the overall adequacy of colonic distension nor the accuracy of polyp detection. In patients with sigmoid diverticular disease IV Buscopan improves distension of more proximal colonic segments and may be useful in selected cases, but our results do not support its routine use for CT colonography.     

Defaecography and colonic transit time for the evaluation of female patients with obstructed defaecation

Purpose

Colonic transit time and defaecography are well known, commonly used studies for evaluating patients with chronic constipation. The aim of this study was to compare colonic transit time with radiopaque markers and defaecography in female patients with obstructed defaecation.

Materials and methods

In a prospective observational study, between January 2010 and December 2012, a total of 30 female patients, mean age 60 years, with symptoms of obstructed defaecation were subjected to colonic transit time and defaecography, and divided into two groups: normal or abnormal colon transit time. The results were statistically compared using the Chi-square test.

Results

The comparison of data between colonic transit time and defaecography showed the following groups: group 1 (6/30 = 20 %) with normal colonic transit time but abnormal defaecography, and group 2 (24/30 = 80 %) with abnormal colonic transit time; the latter was further divided into two subgroups: group 2a (4/24 = 17 %), patients with inertia coli; group 2b (20/24 = 83 %), patients with impaired defaecation demonstrated at defaecography. There was a significant statistical difference between the radiological findings in these groups.

Conclusions

This study confirmed the value of both defaecography and colonic transit time in assessing clinically obstructed women. Obstructed defaecation might not always be associated with abnormal colonic transit time. Likewise, not all constipated patients had signs of obstructed defaecation. The differential diagnosis between colonic slow transit constipation and constipation due to pelvic floor disorders is essential for an adequate strategy of care.     

Adult Hirschsprung's disease

Two cases of adult Hirschsprung's disease are reported along with a review of 47 cases reported in the literature. Chronic constipation is present in almost all cases. The barium enema examination may suggest the diagnosis if an area of smooth narrowing with proximal dilatation is seen (83%), but biopsy proof of absence of ganglion cells is necessary. Fourteen per cent of patients had a dilated colon without a narrowed segment. Anal manometry is helpful if it demonstrates absence of normal anorectal inhibitory reflex. Total colonic aganglionosis in the adult has been reported, but is exceptionally unusual. The diagnosis of adult Hirschsprung's disease should be suspected in patients with a history of chronic constipation and appropriate radiographic findings.     

Technical quality of CT colonography in relation with diverticular disease

Objective

The aim of the study is to explore how the technical quality of the examination was affected by diverticular disease.

Materials and methods

We retrospectively evaluated a consecutive series of 78 subjects who underwent CTC for screening (n = 58) or staging (n = 20) colorectal cancer, 38 of them (49%) after an incomplete optical colonoscopy. Patients were administered a mild laxative and a iodinated contrast material for fecal tagging. We scored both the bowel preparation and the overall colon distension as poor, good, or optimal and measured the mean sigmoid colon diameter. We counted the number of diverticula and classified patients as having or not a severe diverticular disease (SDD). The number of the prompts of computer aided diagnosis (CAD) per patient was also considered. Mann–Whitney U and χ² tests were performed.

Results

No CTC complications occurred. The bowel cleansing was poor in 8 (10%) patients, good in 29 (37%) and optimal in 41 (53%); colon distension was poor in 7 (9%) patients, good in 38 (49%), and optimal in 33 (42%). Fifty-four (69%) showed diverticula and 30 (38%) had an SDD. Bowel cleansing and distension were not significantly impaired by neither diverticula (p > 0.590) nor the SDD (p > 0.110). Mean sigmoid colon diameter was reduced in presence of diverticula (28 mm versus 23 mm, p = 0.009) or SDD (26 mm versus 22 mm, p = 0.016). The mean number of CAD prompts per patient was not significantly increased by the presence of SDD (p = 0.829).

Conclusions

Bowel cleansing and distension at CTC were not influenced by the presence of diverticular disease.     

慢性功能性便秘对老年人健康的影响及防治

 目的研究慢性功能性便秘对老年人健康的影响及防治措施.方法对332例老年慢性功能性便秘患者的临床资料进行总结.结果发现诱发和加重老年人慢性功能性便秘的临床因素包括性别、原发病及伴发病等.本组病例某些特定原发病存在明显的性别差异,主要伴发病的发生率为冠心病60.54%、糖尿病28.61%、脑血管疾病16.87%、帕金森病6.93%,而且原发病或伴发病并发3种以上(包括3种)分别为65.66%和59.34%.结论慢性功能性便秘严重影响了老年人的健康,深入探讨其特点及规律,采取积极的应对措施将极大地改善老年人的生活质量.