CT colonography: optimisation,diagnostic performance and patient acceptability of reduced-laxative regimens using barium-based faecal tagging |
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Authors: | Stuart A Taylor Andrew Slater David N Burling Emily Tam Rebecca Greenhalgh Louise Gartner Julia Scarth Robert Pearce Paul Bassett Steve Halligan |
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Institution: | (1) Department of Specialist Radiology, University College Hospital, Euston Road, London, UK;(2) John Radcliffe Hospital, Headington, Oxford, UK;(3) St Mark’s Hospital, Northwick Park, UK;(4) Department of Imaging, University College Hospital, 2F Podium, 235 Euston Road, London, UK, NW1 2BU |
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Abstract: | To establish the optimum barium-based reduced-laxative tagging regimen prior to CT colonography (CTC). Ninety-five subjects
underwent reduced-laxative (13 g senna/18 g magnesium citrate) CTC prior to same-day colonoscopy and were randomised to one
of four tagging regimens using 20 ml 40%w/v barium sulphate: regimen A: four doses, B: three doses, C: three doses plus 220 ml
2.1% barium sulphate, or D: three doses plus 15 ml diatriazoate megluamine. Patient experience was assessed immediately after
CTC and 1 week later. Two radiologists graded residual stool (1: none/scattered to 4: >50% circumference) and tagging efficacy
for stool (1: untagged to 5: 100% tagged) and fluid (1: untagged, 2: layered, 3: tagged), noting the HU of tagged fluid. Preparation
was good (76–94% segments graded 1), although best for regimen D (P = 0.02). Across all regimens, stool tagging quality was high (mean 3.7–4.5) and not significantly different among regimens.
The HU of layered tagged fluid was higher for regimens C/D than A/B (P = 0.002). Detection of cancer (n = 2), polyps ≥6 mm (n = 21), and ≤5 mm (n = 72) was 100, 81 and 32% respectively, with only four false positives ≥6 mm. Reduced preparation was tolerated better than
full endoscopic preparation by 61%. Reduced-laxative CTC with three doses of 20 ml 40% barium sulphate is as effective as
more complex regimens, retaining adequate diagnostic accuracy. |
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Keywords: | Colonography Computed tomography Barium sulfate Cathartics |
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