title: Automated volumetric analysis for comparison of oral sulfate solution (SUPREP) with established cathartic agents at CT colonography.
abstract: OBJECTIVE
  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.
authors: Department of Radiology, University of Wisconsin School of Medicine & Public Health, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA, pbannas@uwhealth.org.
authors: Peter
authors: P
authors: Bannas
authors: Joshua
authors: J
authors: Bakke
authors: James L
authors: JL
authors: Patrick
authors: Perry J
authors: PJ
authors: Pickhardt
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000369:Aged, 80 and over; D002400:Cathartics; D019343:Citric Acid; D003106:Colon / Q000000981:diagnostic imaging; D023881:Colonography, Computed Tomographic; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D010710:Phosphates; D011092:Polyethylene Glycols; D012189:Retrospective Studies; D013431:Sulfates
chemical_list: D002400:Cathartics; D003287:Contrast Media; D009942:Organometallic Compounds; D010710:Phosphates; D013431:Sulfates; D019343:Citric Acid; D011092:Polyethylene Glycols; C110422:magnesium citrate; C018279:sodium phosphate