Image quality and patient acceptance of four regimens with different amounts of mild laxatives for CT colonography.
OBJECTIVE
The purpose of our study was to prospectively evaluate image quality and patient acceptance of CT colonography (CTC) with fecal tagging using different levels of catharsis.


METHODS
Forty consecutive increased-risk patients were randomized. Group 1 received orally 20 mg of bisacodyl, group 2 received 30 mg of bisacodyl, group 3 received 20 mg of bisacodyl and 8.2 g of magnesium citrate, and group 4 received 30 mg of bisacodyl and 16.4 g of magnesium citrate. All patients used a 2-day low-fiber diet and received diatrizoate meglumine and barium for fecal tagging. One reviewer blindly scored subjective image quality (fecal tagging, amount of residual feces [liquid or solid], luminal distention, and image readability) on a 5- to 6-point scale using a 2D review technique. The mean and SD of attenuation of tagging were measured as well as the relative SD as a measure of homogeneity. Furthermore, patient acceptance (burden related to diarrhea, abdominal pain, flatulence, and overall burden) was evaluated. Ordinal regression, generalized estimating equations, and parametric and nonparametric tests were used for analysis.


RESULTS
Image readability was evaluated as good or excellent in all examinations except one in group 2 (nondiagnostic) and two in group 3 (moderate). Group 2 contained more feces than group 4 (p = 0.04). With regard to mean attenuation and homogeneity of tagging, no significant differences were observed between groups. Group 4 experienced more severe diarrhea than groups 1 and 2 and higher overall burden than groups 1 and 3 (p < 0.042).


CONCLUSIONS
The mildest preparation with 20 mg of bisacodyl provided good image quality of CTC images. Increasing the amount of laxatives did not improve image quality or tagging characteristics but was associated with a lower patient acceptance.
Department of Radiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands. s.jensch@amc.uva.nl
Sebastiaan
S
Jensch
Ayso H
AH
de Vries
Dennis
D
Pot
Jan
J
Peringa
Shandra
S
Bipat
Jasper
J
Florie
Rogier E
RE
van Gelder
Jaap
J
Stoker
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001726:Bisacodyl / Q000008:administration & dosage*; D023881:Colonography, Computed Tomographic / Q000379:methods*; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D054368:Laxatives / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011856:Radiographic Image Enhancement / Q000379:methods*
D054368:Laxatives; D001726:Bisacodyl