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Image Quality and Patient Acceptance of Four Regimens with Different Amounts of Mild Laxatives for CT Colonography

¹ Department of Radiology, (G1-215), Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1100 DD, Amsterdam, The Netherlands.
² Department of Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

View larger version (70K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Axial multiplanar reformatted coronal and endoluminal 3D images show subjective evaluation in four different patients with various grades of fecal tagging. In 50-year-old man with abdominal pain and family history of colorectal cancer, reviewer evaluated fecal tagging as excellent.

View larger version (69K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Axial multiplanar reformatted coronal and endoluminal 3D images show subjective evaluation in four different patients with various grades of fecal tagging. In 51-year-old woman with history of colorectal polyps, reviewer evaluated fecal tagging as good.

View larger version (67K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —Axial multiplanar reformatted coronal and endoluminal 3D images show subjective evaluation in four different patients with various grades of fecal tagging. In 61-year-old man with history of colorectal cancer, reviewer evaluated fecal tagging as moderate.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —Axial multiplanar reformatted coronal and endoluminal 3D images show subjective evaluation in four different patients with various grades of fecal tagging. In 72-year-old man with history of colorectal cancer, reviewer evaluated fecal tagging as poor.

View larger version (79K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Axial multiplanar reformatted coronal and endoluminal 3D image shows mean attenuation and SD of fecal material in 63-year-old man with family history of colorectal cancer. Inset histogram shows attenuation values in Hounsfield units of tagged material (x-axis) and frequencies of measurement (y-axis). Observer placed region of interest with surface area of at least 60 mm2 in largest fluid level on randomized computer-picked slice, and CT colonography software subsequently provided mean attenuation and SD.

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —Graphs show subjective image quality scores on per-segment basis. Displays on y-axis proportion of segments and on x-axis preparation groups. Fecal tagging (A) and amount of feces (B) were scored on supine images (for group 1, 66 segments; group 2, 58 segments; group 3, 60 segments; and group 4, 54 segments). Distention (C) and diagnostic readability (D) were scored on supine and prone images (132, 120, 210, and 108 segments, respectively). Group 2 performed significantly poorer with regard to amount of residual feces in comparison with group 4 (p = 0.04).

View larger version (14K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —Graphs show subjective image quality scores on per-segment basis. Displays on y-axis proportion of segments and on x-axis preparation groups. Fecal tagging (A) and amount of feces (B) were scored on supine images (for group 1, 66 segments; group 2, 58 segments; group 3, 60 segments; and group 4, 54 segments). Distention (C) and diagnostic readability (D) were scored on supine and prone images (132, 120, 210, and 108 segments, respectively). Group 2 performed significantly poorer with regard to amount of residual feces in comparison with group 4 (p = 0.04).

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3C —Graphs show subjective image quality scores on per-segment basis. Displays on y-axis proportion of segments and on x-axis preparation groups. Fecal tagging (A) and amount of feces (B) were scored on supine images (for group 1, 66 segments; group 2, 58 segments; group 3, 60 segments; and group 4, 54 segments). Distention (C) and diagnostic readability (D) were scored on supine and prone images (132, 120, 210, and 108 segments, respectively). Group 2 performed significantly poorer with regard to amount of residual feces in comparison with group 4 (p = 0.04).

View larger version (12K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3D —Graphs show subjective image quality scores on per-segment basis. Displays on y-axis proportion of segments and on x-axis preparation groups. Fecal tagging (A) and amount of feces (B) were scored on supine images (for group 1, 66 segments; group 2, 58 segments; group 3, 60 segments; and group 4, 54 segments). Distention (C) and diagnostic readability (D) were scored on supine and prone images (132, 120, 210, and 108 segments, respectively). Group 2 performed significantly poorer with regard to amount of residual feces in comparison with group 4 (p = 0.04).

View larger version (11K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Graph shows proportion of solid feces in colon on per-segment basis (if feces was not solid it was considered liquid). Most segments contained only little feces with solid consistency (0–20%) in every preparation (black bars). However, group 4 contained significantly less solid feces compared with groups 1, 2, and 3 (p = 0.004, p = 0.002, p < 0.001).

View larger version (10K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Graph shows patient preference 5 weeks after colonoscopy. Patients (n = 40) indicated whether they preferred CT colonography (CTC) or colonoscopy (CC) as colorectal examination in the future. Most patients (n = 30) preferred CTC.

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