Jake Theis1, David H Kim1, Meghan G Lubner1, Alejandro Muñoz del Rio1, Perry J Pickhardt2,3. 1. Department of Radiology, University of Wisconsin School of Medicine & Public Health, 750 Highland Avenue, Madison, WI, 53705, USA. 2. Department of Radiology, University of Wisconsin School of Medicine & Public Health, 750 Highland Avenue, Madison, WI, 53705, USA. ppickhardt2@uwhealth.org. 3. Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA. ppickhardt2@uwhealth.org.
Abstract
PURPOSE: To objectively compare the volume, density, and distribution of luminal fluid for same-day oral-contrast-enhanced CTC following incomplete optical colonoscopy (OC) vs. deferred CTC on a separate day utilizing a dedicated CTC bowel preparation. METHODS: HIPAA-compliant, IRB-approved retrospective study compared 103 same-day CTC studies after incomplete OC (utilizing 30 mL oral diatrizoate) against 151 CTC examinations performed on a separate day after failed OC using a dedicated CTC bowel preparation (oral magnesium citrate/dilute barium/diatrizoate the evening before). A subgroup of 15 patients who had both same-day CTC and separate-day routine CTC was also identified and underwent separate analysis. CTC exams were analyzed for opacified fluid distribution within the GI tract, as well as density and volume. Data were analyzed utilizing Kruskal-Wallis and Wilcoxon Signed Rank tests. RESULTS: Opacified luminal fluid extended to the rectum in 56% (58/103) of same-day CTC vs. 100% (151/151) of deferred separate-day CTC (p < 0.0001). For same-day CTC, contrast failed to reach the colon in 11% (11/103) and failed to reach the left colon in 26% (27/103). Volumetric colonic fluid segmentation for fluid analysis (successful in 80 same-day and 147 separate-day cases) showed significantly more fluid in the same-day cohort (mean, 227 vs. 166 mL; p < 0.0001); the actual difference is underestimated due to excluded cases. Mean colonic fluid attenuation was significantly lower in the same-day cohort (545 vs. 735 HU; p < 0.0001). Similar findings were identified in the smaller cohort with direct intra-patient CTC comparison. CONCLUSIONS: Dedicated CTC bowel preparation on a separate day following incomplete OC results in a much higher quality examination compared with same-day CTC.
PURPOSE: To objectively compare the volume, density, and distribution of luminal fluid for same-day oral-contrast-enhanced CTC following incomplete optical colonoscopy (OC) vs. deferred CTC on a separate day utilizing a dedicated CTC bowel preparation. METHODS: HIPAA-compliant, IRB-approved retrospective study compared 103 same-day CTC studies after incomplete OC (utilizing 30 mL oral diatrizoate) against 151 CTC examinations performed on a separate day after failed OC using a dedicated CTC bowel preparation (oral magnesium citrate/dilute barium/diatrizoate the evening before). A subgroup of 15 patients who had both same-day CTC and separate-day routine CTC was also identified and underwent separate analysis. CTC exams were analyzed for opacified fluid distribution within the GI tract, as well as density and volume. Data were analyzed utilizing Kruskal-Wallis and Wilcoxon Signed Rank tests. RESULTS: Opacified luminal fluid extended to the rectum in 56% (58/103) of same-day CTC vs. 100% (151/151) of deferred separate-day CTC (p < 0.0001). For same-day CTC, contrast failed to reach the colon in 11% (11/103) and failed to reach the left colon in 26% (27/103). Volumetric colonic fluid segmentation for fluid analysis (successful in 80 same-day and 147 separate-day cases) showed significantly more fluid in the same-day cohort (mean, 227 vs. 166 mL; p < 0.0001); the actual difference is underestimated due to excluded cases. Mean colonic fluid attenuation was significantly lower in the same-day cohort (545 vs. 735 HU; p < 0.0001). Similar findings were identified in the smaller cohort with direct intra-patient CTC comparison. CONCLUSIONS: Dedicated CTC bowel preparation on a separate day following incomplete OC results in a much higher quality examination compared with same-day CTC.
Authors: Perry J Pickhardt; J Richard Choi; Inku Hwang; James A Butler; Michael L Puckett; Hans A Hildebrandt; Roy K Wong; Pamela A Nugent; Pauline A Mysliwiec; William R Schindler Journal: N Engl J Med Date: 2003-12-01 Impact factor: 91.245
Authors: Andrew Slater; Stuart A Taylor; David Burling; Louise Gartner; Julia Scarth; Steve Halligan Journal: Radiology Date: 2006-07 Impact factor: 11.105
Authors: David H Kim; Perry J Pickhardt; J Louis Hinshaw; Andrew J Taylor; Rajat Mukherjee; Patrick R Pfau Journal: J Comput Assist Tomogr Date: 2007 Jan-Feb Impact factor: 1.826
Authors: David H Kim; Kristina A Matkowskyj; Meghan G Lubner; J Louis Hinshaw; Alejandro Munoz Del Rio; B Dustin Pooler; Jennifer M Weiss; Perry J Pickhardt Journal: Radiology Date: 2016-02-15 Impact factor: 11.105
Authors: Cesare Hassan; Perry J Pickhardt; Perry Pickhardt; Andrea Laghi; Daniel H Kim; Daniel Kim; Angelo Zullo; Franco Iafrate; Lorenzo Di Giulio; Sergio Morini Journal: Arch Intern Med Date: 2008-04-14
Authors: Steve Halligan; Kate Wooldrage; Edward Dadswell; Ines Kralj-Hans; Christian von Wagner; Rob Edwards; Guiqing Yao; Clive Kay; David Burling; Omar Faiz; Julian Teare; Richard J Lilford; Dion Morton; Jane Wardle; Wendy Atkin Journal: Lancet Date: 2013-02-14 Impact factor: 79.321