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Optimizing Colonic Distention for Multi–Detector Row CT Colonography: Effect of Hyoscine Butylbromide and Rectal Balloon Catheter¹

¹ From the Intestinal Imaging Centre (S.A.T., S.H., V.G., S.M., P.B., C.I.B.) and Cancer Research UK Colorectal Cancer Unit (S.H., W.A.), Level 4V, St Mark’s Hospital, Watford Rd, Northwick Park, Harrow, Middlesex HA1 3UJ, England. Received September 20, 2002; revision requested November 26; final revision received February 5, 2003; accepted March 10. S.A.T. supported by a research fellowship from the Royal College of Radiologists and by GE Medical Systems, Slough, England. Address correspondence to S.H. (e-mail: s.halligan@ic.ac.uk).

View larger version (148K): [in a new window]   Figure 1a. (a) Inflated rectal balloon catheter. (b) Standard thin rectal tube. The same pencil (placed to facilitate comparison) is shown in a and b.

View larger version (52K): [in a new window]   Figure 1b. (a) Inflated rectal balloon catheter. (b) Standard thin rectal tube. The same pencil (placed to facilitate comparison) is shown in a and b.

View larger version (178K): [in a new window]   Figure 2a. Series of transverse CT colonographic images demonstrate the scoring system used to grade colonic distention. (a) Grade 0 distention: The colon (arrows) is completely collapsed and has no identifiable lumen. (b) Grade 1 distention: The colon is partially collapsed. Note the absence of a clear central navigatory path owing to the meeting of thickened haustral folds (arrow) within the colonic lumen. (c) Grade 2 distention: The colon is reasonably but suboptimally distended. The colonic wall (arrow) is easily visible, but there is a clear central pathway through the segment. (d) Grade 3 distention: The colon is optimally distended. Note that the colonic wall (arrow) is barely visible.

View larger version (134K): [in a new window]   Figure 2b. Series of transverse CT colonographic images demonstrate the scoring system used to grade colonic distention. (a) Grade 0 distention: The colon (arrows) is completely collapsed and has no identifiable lumen. (b) Grade 1 distention: The colon is partially collapsed. Note the absence of a clear central navigatory path owing to the meeting of thickened haustral folds (arrow) within the colonic lumen. (c) Grade 2 distention: The colon is reasonably but suboptimally distended. The colonic wall (arrow) is easily visible, but there is a clear central pathway through the segment. (d) Grade 3 distention: The colon is optimally distended. Note that the colonic wall (arrow) is barely visible.

View larger version (135K): [in a new window]   Figure 2c. Series of transverse CT colonographic images demonstrate the scoring system used to grade colonic distention. (a) Grade 0 distention: The colon (arrows) is completely collapsed and has no identifiable lumen. (b) Grade 1 distention: The colon is partially collapsed. Note the absence of a clear central navigatory path owing to the meeting of thickened haustral folds (arrow) within the colonic lumen. (c) Grade 2 distention: The colon is reasonably but suboptimally distended. The colonic wall (arrow) is easily visible, but there is a clear central pathway through the segment. (d) Grade 3 distention: The colon is optimally distended. Note that the colonic wall (arrow) is barely visible.

View larger version (122K): [in a new window]   Figure 2d. Series of transverse CT colonographic images demonstrate the scoring system used to grade colonic distention. (a) Grade 0 distention: The colon (arrows) is completely collapsed and has no identifiable lumen. (b) Grade 1 distention: The colon is partially collapsed. Note the absence of a clear central navigatory path owing to the meeting of thickened haustral folds (arrow) within the colonic lumen. (c) Grade 2 distention: The colon is reasonably but suboptimally distended. The colonic wall (arrow) is easily visible, but there is a clear central pathway through the segment. (d) Grade 3 distention: The colon is optimally distended. Note that the colonic wall (arrow) is barely visible.

View larger version (163K): [in a new window]   Figure 3a. Achievement of adequate segment distention with dual positioning. (a) Transverse CT image through the pelvis acquired with the patient in the prone position shows complete collapse of the rectum (arrow). (b) Transverse CT image acquired after but at the same level as a with the patient in the supine position. The rectum (arrow) is now fully distended.

View larger version (134K): [in a new window]   Figure 3b. Achievement of adequate segment distention with dual positioning. (a) Transverse CT image through the pelvis acquired with the patient in the prone position shows complete collapse of the rectum (arrow). (b) Transverse CT image acquired after but at the same level as a with the patient in the supine position. The rectum (arrow) is now fully distended.