Comparison of Water, Mannitol and Positive Oral Contrast for Evaluation of Bowel By Computed Tomography

• Main Authors: Padhmanaban Elamparidhi, Selvakkalanjiyam Sivaranjanie, Rudrappa Ramesh Kumar, Rajkumar Sibhithran, A. Amaresh Kumar
• Format: Article
• Language: English
• Published: JCDR Research and Publications Pvt. Ltd. 2017-10-01
• Series: International Journal of Anatomy Radiology and Surgery
• Subjects: Bowel distention; Endoluminal contrast; Mural fold visibility
• Online Access: http://www.ijars.net/articles/PDF/2316/29481_CE(VSU)_F(AK)_PF1(VSUAK)_PFA(VSU_GG)_PF2(VSU_GG).pdf

Introduction: Small bowel remains a challenging anatomical site. Imaging approaches like CT-enterography helps in diagnosing non specific clinical presentations and imaging aids in appropriate management. Hence, bowel evaluation by CT requires a oral contrast agent for diagnosing the bowel pathology. Thus, quantitative and qualitative analysis of three oral contrast agents i.e., water, mannitol and positive contrast was done for identification of ideal intraluminal contrast agent. Aim: To assess the performance of mannitol as an endoluminal contrast agent as compared to water and positive contrast in the evaluation of bowel, to compare the distention of bowel with different oral contrasts and also to assess the usefulness of bowel distension in assessment of mural enhancement pattern of bowel. Materials and Methods: A comparative observational study was performed which consisted of 75 patients who were divided into three groups of 25 patients each. Patients in each group were given 1500 ml of oral contrast. Group I was given mannitol, Group II was given water and Group III was given positive contrast. Assessments of bowel distention at various levels and mural enhancement of bowel were studied. Chisquare test was used as test of significance for qualitative data. ANOVA (Analysis of Variance) was the test of significance for quantitative data. Results: Bowel distention was excellent in mannitol compared to water and positive contrast. Wall enhancement and mural pattern was better appreciated with mannitol compared to other two contrast agents. Conclusion: Adequate bowel evaluation by CT requires an oral contrast agent which can cause maximal bowel distention, uniform intraluminal attenuation, increased contrast between intraluminal content and bowel wall with no artifacts and adverse effects. Mannitol has all the above characteristic and can be used as ideal neutral oral contrast agent.