Basic Arterial Anatomy and Interpretation of CT Angiography for Intra-Abdominal or Gastrointestinal Bleeding: Correlation with Conventional Angiographic Findings for Beginners

It is essential to identify the causative artery in case of active intra-abdominal or gastrointestinal bleeding. A thorough understanding of the basic arterial anatomy is required to identify the causative artery on contrast-enhanced CT angiography and conventional catheter angiography. If one is familiar with the basic arterial anatomy, obtaining access to the bleeding artery will be easier, despite the variations in the origin and course of the vessels. We describe the basic arterial anatomy that will help beginners in diagnostic radiology to identify the blood vessels that can cause active intra-abdominal or gastrointestinal bleeding.

Incidence and Risk Factors of Infectious Complications Related to Implantable Venous-Access Ports

OBJECTIVE: The purpose of this study was to determine the incidence and risk factors of infections associated with implantable venous access ports (IVAPs). MATERIALS AND METHODS: From August 2003 through November 2011, 1747 IVAPs were placed in our interventional radiology suite. One hundred forty four IVAPs were inserted in patients with hematologic malignancy and 1603 IVAPs in patients with solid tumors. Among them, 40 ports (23 women and 17 men; mean age, 57.1 years; range, 13-83) were removed to treat port-related infections. We evaluated the incidence of port-related infection, patient characteristics, bacteriologic data, and patient progress. Univariable analyses (t test, chi-square test, and Fisher's exact test) and multiple logistic regression analyses were used to determine the risk factors for IVAP related infection. RESULTS: Overall, 40 (2.3%) of 1747 ports were removed for symptoms of infection with an incidence rate of 0.067 events/1000 catheter-days. According to the univariable study, the incidences of infection were seemingly higher in the patients who received the procedure during inpatient treatment (p = 0.016), the patients with hematologic malignancy (p = 0.041), and the patients receiving palliative chemotherapy (p = 0.022). From the multiple binary logistic regression, the adjusted odds ratios of infection in patients with hematologic malignancies and those receiving palliative chemotherapy were 7.769 (p = 0.001) and 4.863 (p = 0.003), respectively. Microorganisms were isolated from 26 (65%) blood samples, and two of the most causative organisms were found to be Staphylococcus (n = 10) and Candida species (n = 7). CONCLUSION: The underlying hematologic malignancy and the state of receiving palliative chemotherapy were the independent risk factors of IVAP-related infection.

Percutaneous Placement of Self-Expandable Metallic Stents in Patients with Obstructive Jaundice Secondary to Metastatic Gastric Cancer after Gastrectomy

OBJECTIVE: To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. MATERIALS AND METHODS: Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. RESULTS: The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL +/- 6.8 before stent insertion, decreased to 4.58 mg/dL +/- 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 +/- 99 days, and the median patient survival was 179 +/- 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). CONCLUSION: Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.

A case of necrotizing pancreatitis subsequent to transcatheter arterial chemoembolization in a patient with hepatocellular carcinoma

Necrotizing pancreatitis is one of the rare complications of transcatheter arterial chemoembolization (TACE). Necrotizing pancreatitis after TACE may result from the development of ischemia caused by regurgitation of embolic materials into the vessels supplying the pancreas. We report a case of post-TACE necrotizing pancreatitis with abscess formation in a patient with hepatocellular carcinoma. The patient had suffered hepatic artery injury due to repetitive TACE; during his 25th TACE procedure he had submitted to selective catheterization of the feeding vessel from the dorsal pancreatic artery with a cytotoxic agent and Gelfoam particles. The patient complained of abdominal pain after the TACE procedure, and a CT scan led to a diagnosis of necrotizing pancreatitis with abscess formation. The pancreatic abscess progressed despite general management of the pancreatitis, including antibiotics. Percutaneous catheter drainage was performed, and the symptoms of the patient improved.

Prophylactic Hypogastric Artery Ballooning in a Patient with Complete Placenta Previa and Increta

Abnormal attachment of the placenta (Placenta accreta, increta, and percreta) is an uncommon but potentially lethal cause of maternal mortality from massive postpartum hemorrhage. A 33-yr-old woman, who had been diagnosed with a placenta previa, was referred at 30 weeks gestation. On ultrasound, a complete type of placenta previa and multiple intraplacental lacunae, suggestive of placenta accreta, were noted. For further evaluation of the placenta, pelvis MRI was performed and revealed findings suspicious of a placenta increta. An elective cesarean delivery and subsequent hysterectomy were planned for the patient at 38 weeks gestation. On the day of delivery, endovascular catheters for balloon occlusion were placed within the hypogastric arteries, prior to the cesarean section. In the operating room, immediately after the delivery of the baby, bilateral hypogastric arteries were occluded by inflation of the balloons in the catheters previously placed within. With the placenta retained within the uterus, a total hysterectomy was performed in the usual fashion. The occluding balloons were deflated after closure of the vaginal cuff with hemostasis. The patient had stable vital signs and normal laboratory findings during the recovery period; she was discharged six days after delivery without complications. The final pathology confirmed a placenta increta.

Spontaneously Migrated Tip of an Implantable Port Catheter into the Axillary Vein in a Patient with Severe Cough and the Subsequent Intervention to Reposition It

Migration of an implantable port catheter tip is one of the well-known complications of this procedure, but the etiology of this problem is not clear. We describe here a case of migration of the tip of a port catheter from the right atrium to the right axillary vein in a patient with severe cough. Coughing was suggested for this case as the cause of the catheter tip migration. We corrected the position of the catheter tip via transfemoral snaring.

Placement of a Covered Self-expandable Nitinol Stent for Bile Duct Stricture that was Caused by Ischemic Injury after Transcatheter Arterial Chemoembolization in a Patient with Hepatocellular Carcinoma: A Case Report

The authors report here on a case of focal stricture in the common hepatic duct that was caused by ischemic bile duct injury after repeat TACE procedures for hepatocellular carcinoma, and the patient was successfully treated with a covered self-expandable nitinol stent.

Efficacy of a Paclitaxel-Eluting Nitinol Stent on the Inhibition of Pseudointimal Hyperplasia in a Transjugular Intrahepatic Portosystemic Shunt: An Experimental Study in a Swine Model

PURPOSE: To evaluate the efficacy of a paclitaxel-eluting nitinol stent on the inhibition of pseudointimal hyperplasia in a transjugular intrahepatic portosystemic shunt. MATERIALS AND METHODS: Twelve pigs were used in this study. Two types of 10-mm diameter and 60-mm long nitinol stents were made for a transjugular intrahepatic portosystemic shunt by coating them with a polyurethane solution, with and without paclitaxel. Each transjugular intrahepatic portosystemic shunt was created successfully in the 12 swine with 7 paclitaxel-eluting stents and 5 polyurethane stents. Five swine in each group were followed-up for 14 days due to the death of 2 swine given the paclitaxel-eluting stents. The proliferation of the pseudointima was evaluated on both follow-up portograms and histopathology examinations. The mean maximum pseudointimal hyperplasia is expressed as the percentage of the stent radius. RESULTS: On the portograms, all the transjugular intrahepatic portosystemic shunts using the paclitaxel-eluting stents maintained patency despite there being a complete occlusion of the polyurethane stents in all the animals. The histopathology analysis revealed the mean maximum pseudointimal hyperplasia to be 25% and 76% in the paclitaxel-eluting and control stents, respectively. CONCLUSION: A transjugular intrahepatic portosystemic shunt with a paclitaxel-eluting nitinol stent appears to significantly inhibit the formation of pseudointimal hyperplasia.

Spontaneous Tilting after Placement of the Gunther-Tulip Inferior Vena Caval Filter: A Case Report

Tilting of a deployed filter in the inferior vena cava (IVC) is a particular kind of periprocedural complication and this can reduce the filter's clot-trapping ability and increase the occlusion of the IVC at a later period. The authors report here on a case of spontaneous tilting of an inferior vena caval filter that was associated with thrombosis in the IVC within 2 weeks of the initially successful placement of the filter without tilting.

Isolated Bilateral Internal Iliac Aneurysms; Surgical or Endovascular Repair

This report describes the open surgical or endovascular treatment of two patients with bilateral internal iliac artery aneurysms (IIAA). To prevent pelvic ischemia, complete aneurysmal resection and pelvic revascularization with an interposition graft was performed in the open surgical case. Endovascular repair including coil embolization of IIAA and stent-graft placement in the common iliac artery was done successfully in the other case. The contralateral IIAA was left undisturbed and followed for 36 months with no change in size. Prevention of pelvic ischemia is important in the simultaneous treatment of bilateral IIAA.

Efficacy of a Dexamethasone-Eluting Nitinol Stent on the Inhibition of Pseudointimal Hyperplasia in a Transjugular Intrahepatic Portosystemic Shunt: An Experimental Study in a Swine Model

OBJECTIVE: We wanted to evaluate the feasibility and efficacy of using a dexamethasone (DM) -eluting nitinol stent to inhibit the pseudointimal hyperplasia following stent placement in the transjugular intrahepatic portosystemic shunt tract (TIPS) of a swine. MATERIALS AND METHODS: Fifteen stents were constructed using 0.15 mm-thick nitinol wire; they were 60 mm in length and 10 mm in diameter. The metallic stents were then classified into three types; type 1 and 2 was coated with the mixture of 12% and 20%, respectively, of DM solution and polyurethane (PU), while type 3 was a bare stent that was used for control study. In fifteen swine, each type of stent was implanted in the TIPS tract of 5 swine, and each animal was sacrificed 2 weeks after TIPS creation. The proliferation of the pseudointima was evaluated both on follow-up portogram and pathologic examination. RESULTS: One TIPS case, using the type 1 stent, and two TIPS cases, using the type 2 stent, maintained their luminal patency while the others were all occluded. On the histopathologic analysis, the mean of the maximum pseudointimal hyperplasia was expressed as the percentage of the stent radius that was patent, and these values were 51.2%, 50% and 76% for the type 1, 2, and 3 stents, respectively. CONCLUSION: The DM-eluting stent showed a tendency to reduce the development of pseudointimal hyperplasia in the TIPS tract of a swine model with induced-portal hypertension.

Newly Designed Sheaths for Gastroduodenal Intervention: An Experimental Study in a Phantom and Dogs

OBJECTIVE: To evaluate the usefulness of newly designed sheaths for gastroduodenal intervention in a gastric phantom and dogs. MATERIALS AND METHODS: A regular sheath was made using a polytetrafluoroethylene tube (4 mm in diameter, 90 cm long) with a bent tip (4 cm long, 100 degree angle). For the supported type of sheath, a 5 Fr catheter was attached to a regular sheath to act as a side lumen. To evaluate their supportability, we measured the distance of movement of the sheath's tip within a silicone gastric phantom for three types of sheath, the regular type, supported type, and supported type with a supporting guide wire. The experiments were repeated 30 times, and the results were analyzed using ANOVA with the postHoc test. In addition, an animal experiment was performed in six mongrel dogs (total: 12 sessions) to evaluate the torque and supportability of the sheaths in the stomach, while pushing a guide wire or coil catheter under fluoroscopic guidance. RESULTS: In the guide wire application, the distances of movement of the sheath tip in the three types of sheath, the regular type, supported type, and supported type with supporting guide wire, were 8.40+/-0.51 cm, 6.23+/-0.41 cm, and 4.47+/-0.32 cm, respectively (p < 0.001). In the coil catheter application, the corresponding values were 7.22+/-0.70 cm, 5.61+/-0.31 cm and 3.91+/-0.59 cm, respectively (p < 0.001). All three types of sheath rotated smoothly and enabled both the wires and catheters to be guided toward the pylorus of the dog in all cases. CONCLUSION: The newly designed sheaths can be useful for gastroduodenal intervention.

Inferior Vena Cava Filter Placement in Deep Vein Thrombosis

PURPOSE: Deep vein thrombosis (DVT) is a serious disease which causes life-threatening pulmonary embolism and chronic venous insufficiency. In order to prevent pulmonary embolism, inferior vena cava (IVC) filter placement is commonly performed nowadays. We carried out this study to analyze the patterns of the indications for IVC filter placement, the complications associated with procedure, and the follow-up results. METHOD: We treated 42 patients with acute DVT between September 2001 and November 2002 at Gil Medical Center. Our subjects included 10 patients who underwent IVC filter placement during the same period. Duplex sonography and CT venography were performed in all cases. The filter was placed by one interventional radiologist just after checking the nonselective venography. The patients were followed monthly with a physical examination. Plain abdominal film was checked every 3 months, and CT venography every 6 months. RESULT: The mean age was 55.6 years (range 35~72) and the male-to-female ratio was 1:4. The associated diseases were advanced cancer in 3 cases, intracranial hemorrhage in 2 and spinal cord injury and ankylosis of the hip joint in 1. There were 8 cases of hypercoagulable states; 7 of protein S deficiency, 3 of protein C deficiency and 1 of antithrombin III deficiency. Indications for filter insertion were a contraindication to anticoagulation in 5 cases, recurrent pulmonary embolism in 2, floating IVC thrombosis in 2, complication of anticoagulation in 1, prophylactic use before catheter-directed thrombolysis in 1, and quadriplegia in 1. Four Greenfield filters and six TrapEase filters were used. Filters were deployed at infrarenal IVC in 8 cases and suprarenal IVC in 2 cases. There were no major complications related to the procedure. Late complications were not detected during the 7-month follow-up (range 2~16 months). CONCLUSION: We performed 10 IVC filter placements for therapeutic purpose without any serious complications. A wider range of indications, including prophylactic use, might be considered in the future practice for DVT.

Management of Acute Peripheral Arterial Occlusion

PURPOSE: Treatment modalities of acute limb ischemia have evolved over the last decades, but the morbidity and mortality of the disease still remains high. We performed a retrospective study to analyze the demographics, risk factors, and prognosis of this disease. METHOD: Our subjects included a total of 49 patients (55 limbs) with acute peripheral arterial occlusion who underwent operative procedures between September 1996 and August 2001 at Gil Medical Center. Cases with graft occlusion or blue toe syndrome were excluded. The SVS/ISCVS reporting standards was used. RESULT: Mean age was 64.2 years (range: 25~85) and male-to-female ratio was 1.7 : 1. Clinical categories of ischemia were classified as the following: Viable (I) in 10 cases, Marginally threatened (IIa) in 14, Immediately threatened (IIb) in 17, and Irreversible (III) in 8. There were 40 lower extremity and 8 upper extremity arterial occlusions, and 1 aortic occlusion. The causes of occlusion were thrombosis in 14 and embolism in 35. Thromboembolectomy was performed in 42 cases, bypass graft in 9, primary amputation in 7, thrombolysis in 1, and stent insertion in 1. The 30-day mortality rate was 8%, mainly due to reperfusion injury and underlying cardiopathy. The 30-day major amputation rate was 23.8%. CONCLUSION: An aggressive, prompt operative management is important in saving patients with acute arterial occlusion. Higher amputation rates were related to more severe categories of ischemia at initial presentation. Patient education along with early referral and intervention will possibly reduce the amputation rate.

Transluminal Radio-Frequency Thermal Ablation Using a Stent-Type Electrode: an Experimental Study

PURPOSE: To assess the feasibility of transluminal radiofrequency thermal ablation using a stent-type electrode and to determine, by means of in-vitro and in-vivo animal studies, the appropriate parameters. MATERIALS AND METHODS: In vitro: The radiofrequency electrode used was a self-expandable nitinol stent with 1cm insulated ends. A stent was placed in the portal vein of bovine liver, and ablations at target temperatures of 70, 80, 90, and 100degrees C were performed. Ablated sizes were measured longitudinally. In vivo: Four mongrel dogs were anesthetized, and a stent was inserted in the common bile duct under fluoroscopic guidance through an ultrasound-guided gall bladder puncture site. The ablation temperature was set at 80 degrees C, and each dog underwent proximal and distal esophageal ablations lasting 12 minutes. They were sacrificed immediately. RESULTS: In-vitro: Ablated sizes showed significant correlation with target temperatures (r>0.04; p<0.05). Although most lesions were fusiform, dumbbell-shaped lesions with central thinning were found in two cases in the 70degrees C group. In all cases in the 70 degrees C and 80 degrees C group, the length of the insulated segment was less than 1 cm. In-vivo: At microscopy, tissues at the center of the biliary stent showed more prominent pathological change than those at the periphery while those remote from the stent showed minimal or no change. In esophageal ablations, the mean highest temperature was 48.6 degrees C. Microscopy demonstrated the destruction and shedding of mucosa, edema, and coagulation necrosis of submucosa, but in muscle layers no abnormalities were apparent. CONCLUSION: Transluminal radio-frequency thermal ablation using a stent-type electrode may be useful for elongating patency. The appropriate target temperature for biliary ablation is 80 degrees C.

Iatrogenic Pseudoaneurysm of Iliac-femoral Artery; the Efficacy of Ultrasound-guided Thrombin Injection Therapy

PURPOSE: As a consequence of the widespread application of coronary and peripheral interventional procedures, the incidence of a femoral pseudoaneurysm is increasing. Along with the traditional surgical approach, ultrasound-guided compression or thrombin injection therapy has recently been developed and is widely used to reduce surgical morbidity. The efficacy of these therapies was compared to define the guidelines for treating an iatrogenic femoral pseudoaneurysm in Korean patients. METHODS: Ultrasound-guided therapies were performed prospectively since October 2000. The results of the surgical repair from July 1996 were reviewed retrospectively. A total 22 patients with an iliofemoral pseudoaneurysm were enrolled in this study. RESULTS: Surgical repair was performed in 12 cases, ultrasound-guided compression therapy in 1 case, and ultrasound-guided thrombin injection in 9 cases. A primary closure of the puncture site (11 cases) and an iliac artery interposition graft (1 case) were performed. Postoperative complications developed in 4 cases; wound hematoma, wound infection and ureter injury. Compression therapy was successfully performed in 1 case. A thrombin injection was performed in 9 cases. Immediate thrombotic obliteration of the pseudoaneurysm occurred in all cases. Partial recannalization was detected during follow-up duplex sonography in 1 case, who was successfully treated by an additional thrombin injection. There were no complications associated with the thrombin injection and no recurrence had occurred during the 4 weeks follow-up. CONCLUSION: Thrombin injection therapy is highly efficient, safe, and comfortable. Ultrasound-guided thrombin injection could be the initial treatment of choice for treating iatrogenic femoral pseudoaneurysm.

Percutaneous Transcholecystic Approach for an Experiement of Biliary Stent Placement: An Experimental Study in Dogs

PURPOSE: To determine, in an experimental study of biliary stent placement, the usefulness and safety of the percutaneous transcholecystic approach and the patency of a newly designed biliary stent. MATERIALS AND METHODS: A stent made of 0.15-mm-thick nitinol wire, and 10 mm in diameter and 2 cm in length, was loaded in an introducer with an 8-F outer diameter. The gallbladders of seven mongrel dogs were punctured with a 16-G angiocath needle under sonographic guidance, and cholangiography was performed. After anchoring the anterior wall of the gallbladder to the abdominal wall using a T-fastener, the gallbladder body was punctured again under fluoroscopic guidance. The cystic and common bile ducts were selected using a 0.035-inch guide wire and a cobra catheter, and the stent was placed in the common bile duct. Post-stenting cholangiography was undertaken, and an 8.5-F drainage tube was inserted in the gallbladder. Two dogs were followed-up and sacrificed at 2, 4, and 8 weeks after stent placement, respectively, and the other expired 2 days after stent placement. Follow-up cholangiograms were obtained before aninmal was sacrificed, and a pathologic examination was performed. RESULTS: Stent placement was technically successful in all cases. One dog expired 2 days after placement because of bile peritonitis due to migration of the drainage tube into the peritoneal cavity, but the other six remained healthy during the follow-up period. Cholangiography performed before the sacrifice of each dog showed that the stents were patent. Pathologic examination revealed the proliferation of granulation tissue at 2 weeks, and complete endothelialization over the stents by granulation tissue at 8 weeks. CONCLUSION: Percutaneous transcholecystic biliary stent placement appears to be safe, easy and useful. After placement, the stent was patent during the follow-up period.

Spiral CT for the Measurement of Hepatic Metastatic Mass from Gastrointestinal Malignant Tumor: Relative Value of Arterial, Portal and Delayed Phase Scanning

PURPOSE: To evaluate the relative value of arterial, portal and delayed phase images in the measurement of hepatic metastatic mass arising from gastrointestinal malignant tumor using spiral CT. MATERIALS AND METHODS: Thirty-three with 45 metastatic tumors of the liver underwent tri-phasic spiral CT. For this purpose one or two lesions were chosen in each patient whose primary tumor was shown to be stomach cancer(n=15), colon cancer(n=16), or ileal cancer(n=1). Tumor size ranged from 1 to 12.2 (mean, 4.3)cm. Arterial, portal and delayed phase images were obtained at 30 -35 seconds, 70 -75 seconds, and 3 minutes, respectively, after the injection of contrast materials. Using a work station, two radiologists independently measured the longest diameter of the selected lesions, and a second measurement was taken three days later. Contrast, as well as intra-and interbserver differences among the three phases, was statistically analysed. RESULTS: Intra- and interobserver difference were, espectively, 2.3 and 3.8 mm during the portal phase; 3.3 and 4.6 mm during the arterial phase; and 2.9 and 4.5 mm during the delayed phase. ANOVA with Tukey's multiple comparison showed that none of these differences were statistically significant. Contrast between mass and liver parenchyma was especially clear during the portal phase (p=0.0001, using the Kruskal-Wallis CONCLUSION: Intra- and interobserver differences in the measurement of hepatic metastatic tumors were statistically insignificant during all three phases. The least difference and best contrast were seen during the portal phase.

Staging of Gastric Adenocarcinoma using Two-Phase Spiral CT: Correlation with Pathologic Staging

PURPOSE: To correlate the preoperative staging of gastric adenocarcinoma using two-phase spiral CT withpathologic staging. MATERIALS AND METHODS: One hundred and eighty patients with gastric cancers confirmed duringsurgery underwent two-phase spiral CT, and were evaluated retrospectively. CT scans were obtained in the proneposition after ingestion of water. Scans were performed 35 and 80 seconds after the start of infusion of 120mL ofnon-ionic contrast material with the speed of 3mL/sec. Five mm collimation, 7mm/sec table feed and 5mmreconstruction interval were used. T- and N-stage were determined using spiral CT images, without knowledge of thepathologic results. Pathologic staging was later compared with CT staging. RESULTS: Pathologic T-stage was T1 in70 cases(38.9%), T2 in 33 (18.3%), T3 in 73 (40.6%), and T4 in 4 (2.2%). Type-I or IIa elevated lesions accountedfor 10 of 70 T1 cases(14.3%) and flat or depressed lesions(type IIb, IIc, or III) for 60 (85.7%). PathologicN-stage was N0 in 85 cases(47.2%), N1 in 42 (23.3%), N2 in 31 (17.2%), and N3 in 22 (12.2%). The detection rate ofearly gastric cancer using two-phase spiral CT was 100.0%(10 of 10 cases) among elevated lesions and 78.3%(47 of60 cases) among flat or depressed lesions. With regard to T-stage, there was good correlation between CT image andpathology in 86 of 180 cases (47.8%). Overstaging occurred in 23.3%(42 of 180 cases) and understaging in 28.9%(52of 180 cases). With regard to N-stage, good correlation between CT image and pathology was noted in 94 of 180cases (52.2%). The rate of understaging(31.7%, 57 of 180 cases) was higher than that of overstaging(16.1%, 29 of180 cases)(p<0.001). CONCLUSION: The detection rate of early gastric cancer using two-phase spiral CT was 81.4%,and there was no significant difference in detectability between elevated and depressed lesions. Two-phase spiralCT for determing the T- and N-stage of gastric cancer was not effective ; it was accurate in abont 50% of casesunderstaging tended to occur.

Degree of Mucosal Coating on Double Contrast Barium Enema: Comparison of Distilled Water and Normal Saline as a Suspension

PURPOSE: To evaluate the degree of mucosal coating on double contrast barium enema (DCBE) using barium suspension made with distilled water or normal saline. MATERIALS AND METHODS: Between June 1 and July 30, 1996, fifty-four patients prospectively underwent DCBE using 83% w/v(weight-to-volme) of barium suspension (room temperature, 24 degrees), which was made with 1,200 mL of distilled water (Group 1 ; 29 cases) and normal saline (Group 2 ; 25 cases) per 1 Kg of Solotopr (Taejoon Pharmacy, Seoul, Korea). Bowel preparation and examination methods were the same in both groups, and four projections (erect view, supine view, both decubitus views) were taken. The mucosal coating was graded as excellent, good, ordinary, or poor by three radiologists working independently, and scored from 3 to 0. Significance was analyzed by t-test. RESULTS: Mean grading scores 2.33+/-0.70 in group 1 and1.56+/-0.99 in group 2 (P < 0.003). CONCLUSION: When barium suspension made with distilled water was used, the degree of mucosal coating on DCBE was better than when the suspension was made with normal saline.