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      CT colonography with minimal bowel preparation: evaluation of tagging quality, patient acceptance and diagnostic accuracy in two iodine-based preparation schemes

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          Abstract

          Purpose

          The aim of this study was to compare a 1-day with a 2-day iodine bowel preparation for CT colonography in a positive faecal occult blood test (FOBT) screening population.

          Materials and methods

          One hundred consecutive patients underwent CT colonography and colonoscopy with segmental unblinding. The first 50 patients (group 1) ingested 7*50 ml iodinated contrast starting 2 days before CT colonography. The latter 50 patients (group 2) ingested 4*50 ml iodinated contrast starting 1 day before CT colonography. Per colonic segment measurements of residual stool attenuation and homogeneity were performed, and a subjective evaluation of tagging quality (grade 1–5) was done. Independently, two reviewers performed polyp and carcinoma detection.

          Results

          The tagging density was 638 and 618 HU (p = 0.458) and homogeneity 91 and 86 HU for groups 1 and 2, respectively (p = 0.145). The tagging quality was graded 5 (excellent) in 90% of all segments in group 1 and 91% in group 2 (p = 0.749). Mean per-polyp sensitivity for lesions ≥10 mm was 86% in group 1 and 97% in group 2 (p = 0.355). Patient burden from diarrhoea significantly decreased for patients in group 2.

          Conclusions

          One-day preparation with meglumine ioxithalamate results in an improved patient acceptability compared with 2-day preparation and has a comparable, excellent image quality and good diagnostic performance.

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          Most cited references18

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          Random comparison of guaiac and immunochemical fecal occult blood tests for colorectal cancer in a screening population.

          Despite poor performance, guaiac-based fecal occult blood tests (G-FOBT) are most frequently implemented for colorectal cancer screening. Immunochemical fecal occult blood tests (I-FOBT) are claimed to perform better, without randomized comparison in screening populations. Our aim was to randomly compare G-FOBT with I-FOBT in a screening population. We conducted a population-based study on a random sample of 20,623 individuals 50-75 years of age, randomized to either G-FOBT (Hemoccult-II) or I-FOBT (OC-Sensor). Tests and invitations were sent together. For I-FOBT, the standard cutoff of 100 ng/ml was used. Positive FOBTs were verified with colonoscopy. Advanced adenomas were defined as >or=10 mm, high-grade dysplasia, or >or=20% villous component. There were 10,993 tests returned: 4836 (46.9%) G-FOBTs and 6157 (59.6%) I-FOBTs. The participation rate difference was 12.7% (P < .01). Of G-FOBTs, 117 (2.4%) were positive versus 339 (5.5%) of I-FOBTs. The positivity rate difference was 3.1% (P < .01). Cancer and advanced adenomas were found, respectively, in 11 and 48 of G-FOBTs and in 24 and 121 of I-FOBTs. Differences in positive predictive value for cancer and advanced adenomas and cancer were, respectively, 2.1% (P = .4) and -3.6% (P = .5). Differences in specificities favor G-FOBT and were, respectively, 2.3% (P < .01) and -1.3% (P < .01). Differences in intention-to-screen detection rates favor I-FOBT and were, respectively, 0.1% (P < .05) and 0.9% (P < .01). The number-to-scope to find 1 cancer was comparable between the tests. However, participation and detection rates for advanced adenomas and cancer were significantly higher for I-FOBT. G-FOBT significantly underestimates the prevalence of advanced adenomas and cancer in the screening population compared with I-FOBT.
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            Computed tomographic colonography without cathartic preparation for the detection of colorectal polyps.

            We prospectively compared the performance of low-dose multidetector computed tomographic colonography (CTC) without cathartic preparation with that of colonoscopy for the detection of colorectal polyps. A total of 203 patients underwent low-dose CTC without cathartic preparation followed by colonoscopy. Before CTC, fecal tagging was achieved by adding diatrizoate meglumine and diatrizoate sodium to regular meals. No subtraction of tagged feces was performed. Colonoscopy was performed 3-7 days after CTC. Three readers interpreted the CTC examinations separately and independently using a primary 2-dimensional approach using multiplanar reconstructions and 3-dimensional images for further characterization. Colonoscopy with segmental unblinding was used as reference standard. The sensitivity of CTC was calculated both on a per-polyp and a per-patient basis. For the latter, specificity, positive predictive values, and negative predictive values were also calculated. CTC had an average sensitivity of 95.5% (95% confidence interval [CI], 92.1%-99%) for the identification of colorectal polyps > or =8 mm. With regard to per-patient analysis, CTC yielded an average sensitivity of 89.9% (95% CI, 86%-93.7%), an average specificity of 92.2% (95% CI, 89.5%-94.9%), an average positive predictive value of 88% (95% CI, 83.3%-91.5%), and an average negative predictive value of 93.5% (95% CI, 90.9%-96%). Interobserver agreement was high on a per-polyp basis (kappa statistic range, .61-.74) and high to excellent on a per-patient basis (kappa statistic range, .79-.91). Low-dose multidetector CTC without cathartic preparation compares favorably with colonoscopy for the detection of colorectal polyps.
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              Mechanisms by which wheat bran and oat bran increase stool weight in humans.

              Generally, stool weight is significantly increased by adding sources of insoluble fiber to the diet. Comparable amounts of fiber provided by wheat and oat brans have the same effect on daily stool output, even though > 90% of wheat bran fiber but only 50-60% of oat bran fiber is insoluble. To determine the bases for these increases in stool weight, stool samples collected from 5 men in 2 constant diet studies that determined the effects of wheat and oat brans on large-bowel physiology were fractionated by using a physicochemical procedure into plant, bacterial, and soluble fractions, which were weighed and analyzed for sugar content and composition. Nitrogen, crude fat, and ash outputs were also determined. Wheat bran increased the fecal concentration of sugars and mass of plant material more than did oat bran, whereas oat bran increased fecal bacterial mass more. Each fiber source increased nitrogen, ash, and fat excretion, but excretion of fat was greater with oat bran. The apparent digestibility of plant-derived neutral sugars decreased significantly when wheat but not oat bran was consumed. The apparent digestibility of neutral sugars provided by wheat bran was 56%; the apparent digestibility of those provided by oat bran was 96%. We conclude that bacteria and lipids are major contributors to the increase in stool weight with oat bran consumption, whereas undigested plant fiber is responsible for much of the increase in stool weight with wheat bran consumption. Results are consistent with the hypothesis that oat bran increases stool weight by providing rapidly fermented soluble fiber in the proximal colon for bacterial growth, which is sustained until excretion by fermentation of the insoluble fiber.
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                Author and article information

                Contributors
                +31-205663028 , +31-205669119 , M.H.Liedenbaum@amc.uva.nl
                Journal
                Eur Radiol
                European Radiology
                Springer-Verlag (Berlin/Heidelberg )
                0938-7994
                1432-1084
                26 August 2009
                26 August 2009
                February 2010
                : 20
                : 2
                : 367-376
                Affiliations
                [1 ]Department of Radiology, Academic Medical Centre, Amsterdam, The Netherlands
                [2 ]Department of Radiology, Gelre Hospitals, Apeldoorn, The Netherlands
                [3 ]Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
                [4 ]Academic Medical Center, G1-226, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
                Article
                1570
                10.1007/s00330-009-1570-8
                2814044
                19707769
                67bdd015-861d-43c3-9106-f45ddcebfd77
                © The Author(s) 2009
                History
                : 27 March 2009
                : 1 July 2009
                : 22 July 2009
                Categories
                Gastrointestinal
                Custom metadata
                © European Society of Radiology 2010

                Radiology & Imaging
                colorectal polyps,ct colonography,colorectal carcinoma,patient acceptance,bowel preparation

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