Shortened oral contrast preparation for improved small bowel distension at MR enterography

Purpose: Adequate small bowel distension in MR enterography is important for the evaluation of disease activity in Crohn's disease patients. While distension of the distal small bowel can be achieved using standard oral contrast preparation, proximal small bowel distension remains a common impediment. The aim of this study was to compare small bowel distension between a 60-min oral contrast preparation and a 45-min oral contrast preparation. Methods: Fifty retrospectively included patients with a 60-min oral preparation protocol and 50 prospectively included patients with a 45-min three-portion oral preparation protocol were included in the study. Both groups gradually ingested a total of 1600 mL 2% Mannitol solution during the preparation time. Two observers independently graded distension of the stomach, duodenum, jejunum, ileum, and (neo-) terminal ileum. Total small bowel distension was calculated as the sum of all small bowel segment scores. Individual and averaged observer distension scores were compared between both groups of patients using chi(2) test for ordinal variables. Results: Significant differences in distension for one of both observers in favor of the 45-min protocol were found for the stomach (p = 0.04), duodenum (p = 0.02), jejunum (p = 0.02), and total small bowel (p = 0.02). When distension scores were averaged between observers, the stomach, jejunum, and total small bowel showed a significant difference in favor of the 45-min protocol (p = 0.04, 0.02, and 0.02, respectively). Conclusion: We advise to use a 45-min three-portion oral preparation protocol for MR enterography for improved overall small bowel distension, proximal small bowel distension, and especially jejunal distension