Gulati Kavita, Shah Zarine K, Sainani Nisha, Uppot Raul, Sahani Dushyant V
Department of Abdominal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Eur Radiol. 2008 May;18(5):868-73. doi: 10.1007/s00330-007-0841-5. Epub 2008 Jan 8.
The purpose of the study was to compare the quality of stomach and small bowel marking/labeling using 1,350 ml of low-density barium alone (VoLumen) with 900 ml of low-density barium and 450 ml of water for 16-MDCT scans of the abdomen and pelvis and assess cost benefits with the two protocols. In this IRB approved study, 80 consecutive patients scheduled for routine CECT (contrast-enhanced CT) of the abdomen-pelvis were studied. Patients were randomized into two groups and were administered either 1,350 ml of VoLumen (two bottles at 20-min intervals, one half bottle at 50 min and the last half on the table) or 900 ml of VoLumen (two bottles at 20-min intervals and 450 ml water on the table). Portal venous phase scanning (detector collimation=0.625 mm, speed=18.75 mm, thickness=5 mm) was subsequently performed. Images were reconstructed in axial and coronal plane at the CT console. Two blinded readers used a pre-designed template to assess distension and wall characteristics of the stomach and small bowel on a 5-point scale. Median scores with the two protocols were compared using the Wilcoxon rank sum test. The stomach and small bowel labeling was rated fair to optimal in all patients and did not differ significantly in the two protocols. The mean scores for distension of the small bowel and stomach were comparable. Inter-observer agreement for bowel labeling was found to be excellent (k 0.81). With the use of coronal images there was increased reader confidence in tracing the small bowel with both protocols. Acceptance for two bottles of VoLumen and water was greater among patients as compared to three bottles of VoLumen. Use of two bottles of VoLumen and water combination cost less than three bottles of VoLumen. Stomach and small bowel labeling with administration of 900 ml of VoLumen followed by 450 ml of water is cost effective and compares well to 1,350 ml of VoLumen alone.
本研究的目的是比较单独使用1350毫升低密度钡剂(VoLumen)与900毫升低密度钡剂加450毫升水用于腹部和盆腔16排螺旋CT扫描时胃和小肠的标记/显影质量,并评估两种方案的成本效益。在这项经机构审查委员会批准的研究中,对80例计划进行腹部-盆腔常规CT增强扫描(CECT)的连续患者进行了研究。患者被随机分为两组,分别给予1350毫升VoLumen(两瓶,间隔20分钟,50分钟时给予半瓶,最后半瓶在检查台上)或900毫升VoLumen(两瓶,间隔20分钟,检查台上放置450毫升水)。随后进行门静脉期扫描(探测器准直=0.625毫米,速度=18.75毫米,层厚=5毫米)。在CT控制台以轴位和冠状位重建图像。两名盲法阅片者使用预先设计的模板,以5分制评估胃和小肠的扩张程度及肠壁特征。使用Wilcoxon秩和检验比较两种方案的中位数评分。在所有患者中,胃和小肠的标记均评为中等至最佳,两种方案之间无显著差异。小肠和胃扩张的平均评分相当。发现阅片者之间对肠标记的一致性非常好(k=0.81)。使用冠状位图像时,两种方案下阅片者追踪小肠的信心均增强。与三瓶VoLumen相比,患者对两瓶VoLumen和水的接受度更高。使用两瓶VoLumen和水的组合成本低于三瓶VoLumen。给予900毫升VoLumen后再给予450毫升水进行胃和小肠标记具有成本效益,与单独使用1350毫升VoLumen效果相当。