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Hydro-MRI of the Small Bowel: Effect of Contrast Volume, Timing of Contrast Administration, and Data Acquisition on Bowel Distention

¹ All authors: Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, D-45122 Essen, Germany.

View larger version (14K): [in a new window]   Fig. 1 —Graph shows differences in average distention values at all time points of data acquisition for small-bowel segments. Least distention occurred in proximal jejunum (mean grade, 1.8). Most distention occurred in ileum (maximum rating, 4.1). LBG = locust bean gum with mannitol. VoLumen, E-Z-EM.

View larger version (14K): [in a new window]   Fig. 2A —Influence of type of contrast medium. Graph shows mean grade of bowel distention after ingestion of one of four contrast media without regard to acquisition time points or volume. For duodenum, there were no statistically significant differences between substances. Water, however, proved inferior to other agents for distention of proximal and distal jejunum and ileum. There was no statistical difference among agents B, C, and D for those bowel segments. LBG = locust bean gum with mannitol.

View larger version (156K): [in a new window]   Fig. 2B —Influence of type of contrast medium. 29-year-old woman in good health. MR images show influence of type of contrast medium on duodenum. For duodenum there were no statistically significant differences between substances. All agents administered at volume of 900 mL. Water.

View larger version (149K): [in a new window]   Fig. 2C —Influence of type of contrast medium. 29-year-old woman in good health. MR images show influence of type of contrast medium on duodenum. For duodenum there were no statistically significant differences between substances. All agents administered at volume of 900 mL. Locust bean gum with mannitol.

View larger version (151K): [in a new window]   Fig. 2D —Influence of type of contrast medium. 29-year-old woman in good health. MR images show influence of type of contrast medium on duodenum. For duodenum there were no statistically significant differences between substances. All agents administered at volume of 900 mL. VoLumen (E-Z-EM) with 1.4% sorbitol.

View larger version (140K): [in a new window]   Fig. 2E —Influence of type of contrast medium. 29-year-old woman in good health. MR images show influence of type of contrast medium on duodenum. For duodenum there were no statistically significant differences between substances. All agents administered at volume of 900 mL. VoLumen with 2% sorbitol.

View larger version (102K): [in a new window]   Fig. 2F —Influence of type of contrast medium. 28-year-old man in good health. MR images show influence of type of contrast medium on ileum (arrow). There was no statistical difference among agents in regard to ileal distention. All agents administered at volume of 1,350 mL. Water.

View larger version (98K): [in a new window]   Fig. 2G —Influence of type of contrast medium. 28-year-old man in good health. MR images show influence of type of contrast medium on ileum (arrow). There was no statistical difference among agents in regard to ileal distention. All agents administered at volume of 1,350 mL. Locust bean gum with mannitol.

View larger version (103K): [in a new window]   Fig. 2H —Influence of type of contrast medium. 28-year-old man in good health. MR images show influence of type of contrast medium on ileum (arrow). There was no statistical difference among agents in regard to ileal distention. All agents administered at volume of 1,350 mL. VoLumen with 1.4% sorbitol.

View larger version (111K): [in a new window]   Fig. 2I —Influence of type of contrast medium. 28-year-old man in good health. MR images show influence of type of contrast medium on ileum (arrow). There was no statistical difference among agents in regard to ileal distention. All agents administered at volume of 1,350 mL. VoLumen with 2% sorbitol.

View larger version (17K): [in a new window]   Fig. 3A —Timing of data acquisition. Graph shows mean distention values of all bowel segments depending on time point of image acquisition. LBG = locust bean gum with mannitol.

View larger version (16K): [in a new window]   Fig. 3B —Timing of data acquisition. Graph of results of data analysis for duodenum shows prompt data acquisition after ingestion was essential. Fifteen minutes after ingestion, distention decreased significantly in duodenum and proximal jejunum.

View larger version (111K): [in a new window]   Fig. 3C —Timing of data acquisition. 29-year-old woman in good health. MR images of duodenum (arrow) obtained with 1,350 mL locust bean gum with mannitol. Data analysis showed prompt data acquisition after ingestion was essential in duodenum and proximal jejunum. Time zero.

View larger version (112K): [in a new window]   Fig. 3D —Timing of data acquisition. 29-year-old woman in good health. MR images of duodenum (arrow) obtained with 1,350 mL locust bean gum with mannitol. Data analysis showed prompt data acquisition after ingestion was essential in duodenum and proximal jejunum. Fifteen minutes after contrast ingestion, distention is significantly decreased.

View larger version (104K): [in a new window]   Fig. 3E —Timing of data acquisition. 29-year-old woman in good health. MR images of duodenum (arrow) obtained with 1,350 mL locust bean gum with mannitol. Data analysis showed prompt data acquisition after ingestion was essential in duodenum and proximal jejunum. Thirty minutes after contrast ingestion.

View larger version (104K): [in a new window]   Fig. 3F —Timing of data acquisition. 29-year-old woman in good health. MR images of duodenum (arrow) obtained with 1,350 mL locust bean gum with mannitol. Data analysis showed prompt data acquisition after ingestion was essential in duodenum and proximal jejunum. Forty-five minutes after contrast ingestion.

View larger version (15K): [in a new window]   Fig. 3G —Timing of data acquisition. Graph shows ileal distention had no statistically significant differences for imaging between time zero and 45 minutes after contrast ingestion.

View larger version (104K): [in a new window]   Fig. 3H —Timing of data acquisition. 29-year-old woman in good health. MR images obtained with 1,350 mL VoLumen (E-Z-EM) with 1.4% sorbitol show ileum. Ileal distention had no statistically significant differences for imaging between time zero and 45 minutes after contrast ingestion. Time zero.

View larger version (103K): [in a new window]   Fig. 3I —Timing of data acquisition. 29-year-old woman in good health. MR images obtained with 1,350 mL VoLumen (E-Z-EM) with 1.4% sorbitol show ileum. Ileal distention had no statistically significant differences for imaging between time zero and 45 minutes after contrast ingestion. Fifteen minutes after contrast ingestion.

View larger version (100K): [in a new window]   Fig. 3J —Timing of data acquisition. 29-year-old woman in good health. MR images obtained with 1,350 mL VoLumen (E-Z-EM) with 1.4% sorbitol show ileum. Ileal distention had no statistically significant differences for imaging between time zero and 45 minutes after contrast ingestion. Thirty minutes after contrast ingestion.

View larger version (101K): [in a new window]   Fig. 3K —Timing of data acquisition. 29-year-old woman in good health. MR images obtained with 1,350 mL VoLumen (E-Z-EM) with 1.4% sorbitol show ileum. Ileal distention had no statistically significant differences for imaging between time zero and 45 minutes after contrast ingestion. Forty-five minutes after contrast ingestion.

View larger version (13K): [in a new window]   Fig. 4A —Influence of contrast volume. Graph shows results for all small-bowel segments. Volume of 1,350 mL had best mean results for contrast agents B, C, and D. Results did not improve with increase in volume to 1,800 mL. LBG = locust bean gum with mannitol.

View larger version (15K): [in a new window]   Fig. 4B —Influence of contrast volume. Graph shows moderate increase in duodenal distention with administration of 450 mL, 900 mL, and 1,350 mL of contrast agent.

View larger version (119K): [in a new window]   Fig. 4C —Influence of contrast volume. 29-year-old woman in good health. MR images 5 minutes after ingestion of water show distention of duodenum (arrows). Moderate increase at 450 mL.

View larger version (143K): [in a new window]   Fig. 4D —Influence of contrast volume. 29-year-old woman in good health. MR images 5 minutes after ingestion of water show distention of duodenum (arrows). Moderate increase at 900 mL.

View larger version (128K): [in a new window]   Fig. 4E —Influence of contrast volume. 29-year-old woman in good health. MR images 5 minutes after ingestion of water show distention of duodenum (arrows). Moderate increase at 1,350 mL.

View larger version (133K): [in a new window]   Fig. 4F —Influence of contrast volume. 29-year-old woman in good health. MR images 5 minutes after ingestion of water show distention of duodenum (arrows). No increase at 1,800 mL.

View larger version (14K): [in a new window]   Fig. 4G —Graph shows distention of ileum. Expanding dose from 450 to 1,350 mL led to statistically significant improvement in distention of ileum.

View larger version (133K): [in a new window]   Fig. 4H —Influence of contrast volume. 29-year-old woman in good health. MR images obtained 45 minutes after ingestion of VoLumen (E-Z-EM) with 1.4% sorbitol show ileum. Expanding dose of agent from 450 to 1,350 mL led to statistically significant improvement in distention of ileum (arrows). 450 mL.

View larger version (140K): [in a new window]   Fig. 4I —Influence of contrast volume. 29-year-old woman in good health. MR images obtained 45 minutes after ingestion of VoLumen (E-Z-EM) with 1.4% sorbitol show ileum. Expanding dose of agent from 450 to 1,350 mL led to statistically significant improvement in distention of ileum (arrows). 900 mL.

View larger version (135K): [in a new window]   Fig. 4J —Influence of contrast volume. 29-year-old woman in good health. MR images obtained 45 minutes after ingestion of VoLumen (E-Z-EM) with 1.4% sorbitol show ileum. Expanding dose of agent from 450 to 1,350 mL led to statistically significant improvement in distention of ileum (arrows). 1,350 mL.

View larger version (132K): [in a new window]   Fig. 4K —Influence of contrast volume. 29-year-old woman in good health. MR images obtained 45 minutes after ingestion of VoLumen (E-Z-EM) with 1.4% sorbitol show ileum. Expanding dose of agent from 450 to 1,350 mL led to statistically significant improvement in distention of ileum (arrows). 1,800 mL.

View larger version (12K): [in a new window]   Fig. 5 —Graph shows side effects and subject acceptance at volume of 1,800 mL. Consumption of 1,800 mL of contrast agents B, C, and D led to rate of side effects significantly higher than that with water (mean score, agent A, 1; agent B, 2.8; agent C, 3.7; agent D, 3.8). LBG = locust bean gum with mannitol. VoLumen, E-Z-EM.

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