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

ABSTRACT: Adequate 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.Fifty 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 χ (2) test for ordinal variables.Significant 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).We 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.

SUBMITTER: Bekendam MI

PROVIDER: S-EPMC5556127 | biostudies-other | 2017 Apr

REPOSITORIES: biostudies-other

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Project description:ObjectivesTo compare the distention quality and patient experience of oral mannitol and polyethylene glycol (PEG) for MRE.MethodsThis study is a retrospective, observational study of a subset of patients enrolled in a multicentre, prospective trial evaluating the diagnostic accuracy of MRE for small bowel Crohn's. Overall and segmental MRE small bowel distention, from 105 patients (64 F, mean age 37) was scored from 0 = poor to 4 = excellent by two experienced observers (68 [65%] mannitol and 37 [35%] PEG). Additionally, 130 patients (77 F, mean age 34) completed a questionnaire rating tolerability of various symptoms immediately and 2 days after MRE (85 [65%] receiving mannitol 45 [35%] receiving PEG). Distension was compared between agents and between those ingesting ≤ 1 L or > 1 L of mannitol using the test of proportions. Tolerability grades were collapsed into "very tolerable," "moderately tolerable," and "not tolerable."ResultsPer patient distension quality was similar between agents ("excellent" or "good" in 54% [37/68] versus 46% [17/37]) with mannitol and PEG respectively. Jejunal distension was significantly better with mannitol compared to PEG (40% [27/68] versus 14% [5/37] rated as excellent or good respectively). There was no significant difference according to the volume of mannitol ingested. Symptom tolerability was comparable between agents, although fullness following MRE was graded as "very tolerable" in 27% (12/45) of patients ingesting PEG, verses 44% (37/84) ingesting mannitol, difference 17% (95% CI 0.6 to 34%).ConclusionMannitol-based solutions and PEG generally achieve comparable distension quality and side effect profiles, although jejunal distension is better quality with mannitol. Neither distension quality nor side-effect profile is altered by ingestion of more than 1 L of mannitol.Key points• Mannitol-based and PEG-based oral preparation agents generally achieve comparable distension quality for MRE with the exception of the jejunum which is better distended with mannitol. • Mannitol-based and PEG-based oral preparation agents used for MRE have similar side effect profiles. • Neither distension quality nor side-effect profile is altered by ingestion of more than 1 L of mannitol.

Project description:PurposeThis study seeks to evaluate the use of quantitative texture parameters extracted from multiphasic contrast-enhanced magnetic resonance (MR) imaging in differentiating between benign and malignant masses (oncocytoma vs. clear cell and papillary RCC) and between common subtypes of renal cell carcinoma (clear cell vs. papillary RCC) in small renal masses (< 4 cm).MethodOne-hundred and forty-two renal lesions (90 clear cell and 22 papillary RCCs; 30 oncocytomas) were identified in a cohort of 41 patients (18 men, 23 women: mean age, 52.8 ± 14.4 years) who underwent preoperative multiphasic contrast-enhanced MR with four phases (unenhanced, arterial, venous, and delayed) between 2015 and 2016. In this study, texture features were extracted from entire cross-sectional tumoral region in three consecutive slices containing the largest cross-sectional area from each of the four phases. The change in imaging feature between precontrast imaging and each postcontrast phase was calculated. Data dimension reduction and feature selection were performed by conducting (1) pairwise Wilcoxon rank test followed by modified false discovery rate adjustment, and (2) Lasso regression. Multivariate modeling incorporating the selected features was performed using random forest classification method.ResultsHistogram imaging features were informative variables in differentiating between benign and malignant masses, while textures imaging features were of added value in differentiating between subtypes of RCCs. Papillary RCCs were distinguished from clear cell RCCs (sensitivity 65.5%, specificity 88%, and accuracy 77.9%), oncocytomas from clear cell RCCs (sensitivity 67.3%, specificity 88.9%, and accuracy 79.3%), and oncocytomas from papillary and clear cell RCCs (sensitivity 64.7%, specificity 85.9%, and accuracy 77.9%).ConclusionsA combination of histogram and texture imaging features on multiphasic MR can help differentiate histologic cell types in common small renal masses (< 4 cm).

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

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