TÀI LIỆU HỘI NGHỊ KỸ THUẬT ĐIỆN QUANG VÀ Y HỌC HẠT NHÂN VIỆT NAM LẦN 7 (2019) Nguồn: https://hinhanhykhoa.com/

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Diagnostic Imaging Department
Friendship Hospital
USING ORAL CONTRAST AGENT FOR ABDOMINAL CT
CLINICAL EXPERIENCES
Nguyễn Trung Thành.
g y g
Nguyễn Văn Tuấn.
Nguyễn Thái Bình.
 Case 1:
INTRODUCTION

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 Case 2
INTRODUCTION
INTRODUCTION
 Using oral contrast agents depends on experiences of radiologists and
technicians
 To date, there is no substantial concensus on the optimal and widely
available method for using oral contrast agents in abdominal CT
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OBJECTION
 Presentation of techniques for using oral contrast agents in computed
tomography.
 Flexible experiences for praticing oral contrast agents in commonly
gastrointestinal disease
GASTROINTESTINAL CONTRAST AGENTS
1/ Barium, Baryt ( Barium sulfat ).
2/ Positive oral contrast agents => higher density than wall of bowel
• Gastrographine 380mgI/ml.
• Intravascular contrast agent that is also used for oral.
3/ Negative oral contrast agents=> lower density than wall of bowel
• CO2, O2 or air.
• Milk, pure water…as a negative contrast oral agent for fulfilling stomach,
small intestinal and large interstinal.

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PREPARATION PRIOR TO SCANNING
 Patient
 Contrast agent
 Other devices
PREPARING PATIENTS.
 Abstain from all food and drink for 4-6 hours prior to scanning
 Administer an enema prior to scanning, if suspected gastrointestinal
disorders and other diseases
 Past medical history: allergic, surgery.
 Measuring height and weight of patient
 Explaining for performance preparation and advantages of preparation

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 WATER: SALINE 0.9%
ORAL CONTRAST AGENT
 Neutral contrast agent
 Isotonic solutions keep on fluid in
lumen which do not absorb to
circulatory system.
 Reasonable cost (~10000
vnd/bottle).
 Uncomfortable for taking
 Uncomfortable for taking.
 Some cases may be nauseous or
vomitting.
 Contraindicated for renal failure
patients
 IODINATED SOLUTIONS DILUTED WITH WATER.
ORAL CONTRAST AGENT.
 A positive contrast agent
 Intravascular contrast agents can
be used for orally
 Dispensing ratio: 10-15ml/ bottle
500ml.
 Syringe 5ml, 10ml

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 OTHER DIVICES
OTHER DIVICES
 Bottle and tube.
 Syringe 50ml (fill water into
small balloon of catheter)
 Syringe 200ml (fill water into
lumen of catheter)
 F l t th t
 Foley two-way catheter
 Gel .
 Clamps scissors.
 Nylon sheets , paper.
MAIN PROCEDURES
 Taking saline 0.9%
 Taking iodinated solutions diluted with water/ saline 0.9%
 Using oral contrast during scanning
 Using oral contrast combined with rectal contrast

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TAKING SALINE 0.9% TECHNIQUE
• If patients weigh about 50-60 kilos. Ingesting 500ml water with 60 minutes
prior to scanning.
• Prior to drinking water. Patient should go to toilet.
• Demand pateint doesn’t go to toilet when starting to take oral contrast agents
• Record the time when pateints started taking the medicine
• In some cases, patients need to walk and massage the abdomen clockwise to
allow the water to flow down into the intestine faster.
TECHNIQUE
Technique:
 First bottle: 500ml ingested over first 5
minutes.
 Second bottle: after 10 minutes, 500ml
ingested over 5 minutes
 Third bottle: after 15 minutes, 500ml
ingest over 5 minutes
 Addition 250 ml to fulfill stomach.
45 mins AFTER took the contrast agent

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Iodinated solutions diluted with water
Dispensing ratio:
 Iodine content at 300mg/ml: ratio 12-15ml/ 500ml.
 Iodine content at 350 or 370mg/ml: ratio 10-12ml/ 500ml.
 Note: if the patient took an intestinal bleach before about 2-3
hours, then dispensing ratio: 15-18ml contrast agents /500ml saline
0.9%).
TECHNIQUE
 Technique is applied similar
cases 1
45 mins AFTER took the contrast agent

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USING ORAL CONTRAST
DURING SCANNING
Step 1:Patient drinks a sip of
water and then hold a sip of water
in the mouth
Step 2:. At the beginning of
scanning, ask the patient to
swallow the sip of water
Step 3: The same way as prior to
scanning and after contrast
injection
Dispensing ratio : 6-7ml/ 250ml
salin 0.9 %.
USING RECTAL CONTRAST
COMBINED WITH ORAL CONTRAST
Step 1:The patient drunk 2 bottles of
saline 0.9%(~ 1 liter) prior to
scanning about 20-30 mins
Step 2: On the table, cleaning colon
with about 1 liter of water through
the anus using Foley sonde, then
proceed scanning.
If pateint combined orally and
rectally
rectally
Dispensing ratio: 12-15ml/500ml.
If patient doesn't bowel preparation ,
let him take oral contrast agents and
wait for feeling defecation, proceed
the scanning

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APPLYING ORAL CONTRAST AGENTS
IN COMMON GASTROINTESTINAL DISEASES
ESOPHAGEAL DISEASES
 Esophageal tumor
 Tumor < 1cm
 Lesion at mucous layer
Oral contrast agents: water or saline
0 9%
0.9%
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ESOPHAGEAL DISEASES
 Esophageal tumor
 Follow-up after
esophagectomy
Esophageal fistula
Iodinated solutions diluted
with water (+)
GASTRIC DISEASES
 Gastritis and an ulcer
Tumor or polyp of
gastric
Saline 0.9 % or water
(-)

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GASTRIC DISEASES
Gastric cancer:
Follow up gastric tumor
Follow up postoperative
gastric cancer
Iodinated solutions
diluted with water (+)
GASTRIC DISEASES
 GASTRIC TUMORS
 Follow up lesions
protruding into gastric
lumen
Iodinated solutions
diluted with saline (+).
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SMALL INTESTINAL DISEASES
Suspected to small bowel
bleeding
Follow up inflammatory
bowel disease,intestinal
tuberculosis, Crohn
di
disease
GIST of small intestine.
 Negative oral contrast:
saline 0.9%
SMALL INTESTINAL DISEASES
INTESTINAL TUMORS
Lymphoma of small
intestine.
Following to mesenteric
tumor
tu o
Following to mesenteric
lymphomas
Evaluation of diverticulitis
Iodinated solutions diluted
with water (+)

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APPENDIX DISEASES
 APPENDIX:
Follow up appendicular abscess
Plaston appendicitis
Suspected to appendicitis but not
fi di di l d
finding appendix on ultrasound
Neoplasms of the appendix
Iodinated solutions diluted with
water (+)
COLORECTAL DISEASES
Follow-up colitis.
Detection of polyps of
colorectal
Oral contrast agents +enema
with saline (-).
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 COLON
COLORECTAL DISEASES
 COLON
 Colon tumors
Follow-up after surgery for
colorectal cancer.
Follow up postoperative
colon cancer with
colostomy
Taken iodinated solutions
diluted with saline by orally
combined with enema (+)
 PANCREAS:
DISEASES OF LIVER-PANCREAS-
BILIARY SYSTEM
 PANCREAS:
Pancreatic cancer invasion
Tumors of ampulla of Vater
Postoperative
pancreaticodoudenectomy.
Pancreatic pseudocyst
Pancreatic pseudocyst
Iodinated solutions diluted with
saline(+).

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 DISEASES OF THE GALLBLADDER AND BILIARY TREE.
DISEASES OF LIVER-PANCREAS-
BILIARY SYSTEM
Follow-up biliary tract
neoplasms
Gallbladder tumors
Postoperative biliary enteric
anastomosis .
Iodinated solutions diluted
with water(+).
Follow up biliary stone
disease.
Saline(-).
 IDIOPATHIC ASCITE (ASCITES OF UNKNOWN ORIGIN)
PERITONEAL DISEASE
 IDIOPATHIC ASCITE (ASCITES OF UNKNOWN ORIGIN).
 Ascites not caused by cirrhosis
Suspected for tuberculous
peritonitis, peritonitis, peritoneal
metastases…
Iodinated solutions diluted with
water(+).
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 RETROPERITONEAL
RETROPERITONEAL DISEASES
 RETROPERITONEAL
The differential diagnosis
retroperitoneal masses with
adjacent structures
Retroperitoneal adenopathy.
Iodinated solutions diluted
with water(+) by orally or
orally combined with enema
 PELVIS MASSES
PELVIS DISEASES
 PELVIS MASSES
Follow up ovarian tumors.
Follow up cervical cancer.
Distinguished origin of pelvis
mass from ovary or adjacent
structures
structures
Taken iodinated solutions diluted
with saline by orally combined
with enema

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CONCLUSION
The use of oral contrast agents should be very flexible
It is necessary to have detail medical history of patient
to choose the appropriate oral contrast.
Clearly revealed the lesions that help radiologist make
the diagnosis more accurately and faster
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