Shortened oral contrast preparation for improved small bowel distension at MR enterography

S. K. S. S. Phoa,J. Stoker,C. Y. Nio,C. A. J. Puylaert,M. I. J. Bekendam

doi:10.1007/s00261-017-1133-4

Abstract

PurposeAdequate small bowel distension in MR enterography is important for the evaluation of disease activity in Crohn’s disease patients. While distension of the distal small bowel can be achieved using standard oral contrast preparation, proximal small bowel distension remains a common impediment. The aim of this study was to compare small bowel distension between a 60-min oral contrast preparation and a 45-min oral contrast preparation.MethodsFifty retrospectively included patients with a 60-min oral preparation protocol and 50 prospectively included patients with a 45-min three-portion oral preparation protocol were included in the study. Both groups gradually ingested a total of 1600 mL 2% Mannitol solution during the preparation time. Two observers independently graded distension of the stomach, duodenum, jejunum, ileum, and (neo-) terminal ileum. Total small bowel distension was calculated as the sum of all small bowel segment scores. Individual and averaged observer distension scores were compared between both groups of patients using χ2 test for ordinal variables.ResultsSignificant differences in distension for one of both observers in favor of the 45-min protocol were found for the stomach (p = 0.04), duodenum (p = 0.02), jejunum (p = 0.02), and total small bowel (p = 0.02). When distension scores were averaged between observers, the stomach, jejunum, and total small bowel showed a significant difference in favor of the 45-min protocol (p = 0.04, 0.02, and 0.02, respectively).ConclusionWe advise to use a 45-min three-portion oral preparation protocol for MR enterography for improved overall small bowel distension, proximal small bowel distension, and especially jejunal distension.

Highlights

Adequate small bowel distension in Magnetic resonance (MR) enterography is important for the evaluation of disease activity in Crohn’s disease patients
Using MR enterography, distension is achieved by oral administration of luminal contrast medium, while in MR enteroclysis distension is achieved by administration of luminal contrast medium through a nasojejunal tube [3, 4]
We found an improved overall small bowel distension and jejunal distension using the 45-min oral preparation protocol

Summary

Introduction

Adequate small bowel distension in MR enterography is important for the evaluation of disease activity in Crohn’s disease patients. When distension scores were averaged between observers, the stomach, jejunum, and total small bowel showed a significant difference in favor of the 45-min protocol (p = 0.04, 0.02, and 0.02, respectively). Colonic distension is not the primary goal of MR enterography and can be seen as an unwanted loss of oral contrast medium for proximal small bowel distension. This loss could indicate an inappropriate timing of contrast administration [11, 12]. We hypothesize that a shortened oral contrast administration will improve proximal small bowel distension without reducing distal small bowel distension. The aim of this study was to compare small bowel distension between a 60-min oral contrast preparation and a 45-min oral contrast preparation

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Conclusion