Department of Radiology, University of California, San Francisco, San Francisco Veterans Affairs Medical Center, VAMC, San Francisco, CA 94143, USA.
Radiology. 2011 Oct;261(1):156-64. doi: 10.1148/radiol.11110217. Epub 2011 Aug 24.
To prospectively compare adequacy of colonic cleansing, adequacy of solid stool and fluid tagging, and patient acceptance by using reduced-volume, 2-L polyethylene glycol (PEG) versus magnesium citrate bowel preparations for CT colonography.
This study was approved by the institutional Committee on Human Research and was compliant with HIPAA; all patients provided written consent. In this randomized, investigator-blinded study, 50 patients underwent oral preparation with either a 2-L PEG or a magnesium citrate solution, tagging with oral contrast agents, and subsequent CT colonography and segmentally unblinded colonoscopy. The residual stool (score 0 [best] to 3 [worst]) and fluid (score 0 [best] to 4 [worst]) burden and tagging adequacy were qualitatively assessed. Residual fluid attenuation was recorded as a quantitative measure of tagging adequacy. Patients completed a tolerance questionnaire within 2 weeks of scanning. Preparations were compared for residual stool and fluid by using generalized estimating equations; the Mann-Whitney test was used to compare the qualitative tagging score, mean residual fluid attenuation, and adverse effects assessed on the patient experience questionnaire.
The mean residual stool (0.90 of three) and fluid burden (1.05 of four) scores for PEG were similar to those for magnesium citrate (0.96 [P = .58] and 0.98 [P = .48], respectively). However, the mean fecal and fluid tagging scores were significantly better for PEG (0.48 and 0.28, respectively) than for magnesium citrate (1.52 [P < .01] and 1.28 [P < .01], respectively). Mean residual fluid attenuation was higher for PEG (765 HU) than for magnesium citrate (443 HU, P = .01), and mean interpretation time was shorter for PEG (14.8 minutes) than for magnesium citrate (18.0 minutes, P = .04). Tolerance ratings were not significantly different between preparations.
Reduced-volume PEG and magnesium citrate bowel preparations demonstrated adequate cleansing effectiveness for CT colonography, with better tagging and shorter interpretation time observed in the PEG group. Adequate polyp detection was maintained but requires further validation because of the small number of clinically important polyps.
前瞻性比较小容量 2 升聚乙二醇（PEG）与镁柠檬酸肠道准备用于 CT 结肠成像时的结肠清洁度、固体粪便和液体标记物的充分性以及患者接受度。
本研究经机构人体研究委员会批准，并符合 HIPAA 规定；所有患者均签署了书面同意书。在这项随机、研究者设盲的研究中，50 例患者分别接受 2 升 PEG 或镁柠檬酸溶液口服准备、口服对比剂标记以及随后的 CT 结肠成像和节段性非盲结肠镜检查。定性评估残留粪便（评分 0[最佳]至 3[最差]）和液体（评分 0[最佳]至 4[最差]）负担和标记物充分性。记录残留液体衰减作为标记物充分性的定量测量。患者在扫描后 2 周内完成了耐受性问卷调查。采用广义估计方程比较残留粪便和液体；采用 Mann-Whitney 检验比较定性标记评分、平均残留液体衰减和患者体验问卷评估的不良反应。
PEG 的平均残留粪便（3 分中的 0.90 分）和液体负担（4 分中的 1.05 分）评分与镁柠檬酸相似（0.96[P=.58]和 0.98[P=.48]）。然而，PEG 的粪便和液体标记物评分（分别为 0.48 和 0.28）明显优于镁柠檬酸（分别为 1.52[P <.01]和 1.28[P <.01]）。PEG 的平均残留液体衰减（765 HU）高于镁柠檬酸（443 HU，P=.01），PEG 的平均解释时间（14.8 分钟）短于镁柠檬酸（18.0 分钟，P=.04）。两种准备方法的患者耐受性评分无显著差异。
小容量 PEG 和镁柠檬酸肠道准备用于 CT 结肠成像时均具有足够的清洁效果，PEG 组的标记物更好、解释时间更短。尽管由于临床重要息肉数量较少，需要进一步验证，但已观察到足够的息肉检出率。
