Lee Seul Bi, Kim Seung Ho, Son Jung Hee, Baik Ji Yeon
1 Department of Radiology, Inje University College of Medicine, Haeundae Paik Hospital, Busan, South Korea, 612-030, Korea.
Br J Radiol. 2017 Dec;90(1080):20170352. doi: 10.1259/bjr.20170352. Epub 2017 Oct 27.
To compare small bowel distension and bowel wall visualization among three different patients' positions (supine, sitting and right decubitus) during administration of oral contrast media in preparation for CT enterography (CTE).
A total of 150 consecutive patients (104 males and 46 females; mean age 34.6 years, range 15-78 years) who were scheduled to undergo CTE were recruited. Patients were randomly allocated into the three position groups during oral contrast media administration, and there were 50 patients in each group. Two blinded radiologists independently scored the luminal distension and visualization of the bowel wall using a continuous 5-point scale (1: worst and 5: best) at the jejunum and ileum. The Mann-Whitney U test was used to evaluate differences between any two groups among the three positions for bowel distension and wall visualization.
For ileal distension, the supine and sitting positions performed better than the right decubitus position [for reader 1, mean: 3.4/3.2/2.9 (hereafter, supine/sitting/right decubitus in order), p = 0.002/0.033; for reader 2, 3.3/3.0/2.6, p < 0.001/0.027]. However, there was no significant difference among the three groups for jejunal distension (for reader 1, 2.4/2.3/2.2; for reader 2, 2.4/2.4/2.2, p > 0.05, respectively). For bowel wall visualization, the supine and sitting positions were superior to the right decubitus position for the ileum when scored by one reader (4.0/3.8/3.4, p = 0.001/0.015).
Supine and sitting positions during the administration of oral contrast media provided better ileal distension than the right decubitus position in obtaining CTE. Advances in knowledge: The performance of CTE largely depends on adequate luminal distension and wall visualization. As the terminal ileum is the predominant site of small bowel pathology for inflammatory bowel disease, the supine or sitting position would be preferable for patients who are suspected of having small bowel pathology.
比较在口服对比剂准备进行CT小肠造影（CTE）期间，三种不同患者体位（仰卧位、坐位和右侧卧位）下的小肠扩张情况及肠壁显影情况。
共招募了150例计划接受CTE的连续患者（男性104例，女性46例；平均年龄34.6岁，范围15 - 78岁）。在口服对比剂期间，患者被随机分配到三个体位组，每组50例。两名盲法放射科医生分别在空肠和回肠处使用连续的5分制量表（1：最差，5：最佳）对肠腔扩张和肠壁显影进行评分。采用Mann-Whitney U检验评估三个体位中任意两组之间在肠扩张和肠壁显影方面的差异。
对于回肠扩张，仰卧位和坐位的表现优于右侧卧位[对于阅片者1，均值：3.4/3.2/2.9（此后依次为仰卧位/坐位/右侧卧位），p = 0.002/0.033；对于阅片者2，3.3/3.0/2.6，p < 0.001/0.027]。然而，三组在空肠扩张方面无显著差异（对于阅片者1，2.4/2.3/2.2；对于阅片者2，2.4/2.4/2.2，p均>0.05）。对于肠壁显影，当由一名阅片者评分时，仰卧位和坐位在回肠处优于右侧卧位（4.0/3.8/3.4，p = 0.001/0.015）。
在口服对比剂进行CTE检查时，仰卧位和坐位在回肠扩张方面比右侧卧位表现更好。知识进展：CTE的效果很大程度上取决于充分的肠腔扩张和肠壁显影。由于末端回肠是炎症性肠病小肠病变的主要部位，对于怀疑有小肠病变的患者，仰卧位或坐位可能更可取。
