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JJournal of Science and Technology in the Tropics (2010) 6: 5-9
Figure 4. CT images of abdominopelvis with water
as the contrast medium.
reconstruction and computer workstations for
anatomical reconstruction have made it possible to
interpret every structure in abdominal CT studies,
including organs, vessels, bones and also bowel, in
a single examination (Fig. 4). Besides, ability of CT
that scans at a shorter time greatly eliminates artifacts
caused by peristaltic and respiratory movement. The
results were consistent with previous studies that
stated that positive oral contrast caused more streak
artifacts compared to water [11]. CT images can also
be reconstructed to get detail visualization of bowel
wall [18].
Subtle changes in the bowel wall and its
surrounding fat can be masked with the use of
positive oral contrast agent like gastrografin. The
reasons for this are enhanced bowel wall may have
the same attenuation as the positive contrast of
the lumen and high densities often occur due to
heterogeneous intraluminal distribution, leading to
artifacts with reduced visualization of the bowel wall
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3. Raptopoulos V., Davis M. A., Davidoff A., Karellas
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REFERENCES
and surrounding fat [16]. This may be the reason
for increasing interest in the use of low attenuation
contrast for a wider range of indications. Water is the
primary choice; advantages include low cost, wide
availability, natural and safe for anyone without any
complications [7].
Water showed significantly better contrast between
bowel wall and lumen and for other criteria in
qualitative analysis, including homogeneity in lumen,
delineation of bowel wall and overall quality image,
consistent with other previous studies. Combination
of water that acts as negative oral contrast agent and
intravenous contrast agent that acts as positive contrast
agent give a better appreciation of mural detail.
Mucosal folds can be visualized clearly and actual
bowel wall thickness can be determined. However,
the limitation of using water as an oral contrast agent
is that the patient needs to consume a large quantity
of water, especially for those in-patients who are very
ill. Some of them even vomit after trying to take more
water. Previous study reported that there were cases
of water toxicity after consuming large amount of
water by patients who had chronic renal failure and
congestive heart failure [7]. Water is not a suitable
oral contrast for these types of patients.
In summary, this study showed that water was
comparable to gastrografin as an oral contrast
medium. Qualitative evaluation showed significantly
superior bowel distension and contrast between bowel
wall and lumen. Besides, quantitative measurements
showed better distension of gaster and bowel. Water
is therefore a better choice as oral contrast medium
since it is inexpensive and safe to consume.
4. Turetschek K., Schober E., Wunderbaldinger P.,
Bernhard C., Schima W., Puespoek, A., Vogelsang
H., Moeschl P. and Mostbeck G. (2002) Findings at
Helical CT-Enteroclysis in Symptomatic Patients
With Crohn Disease: Correlation With Endoscopic
and Surgical Findings. Journal of Computer Assisted
Tomography 26: 488-492.
5. Horton K. M., and Fishman E. K. (2004)
Multidetector-row computed tomography and
3-dimensional computed tomography imaging of
small bowel neoplasms: current concept in diagnosis.
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