Comparative efficacy of and sequence choice for two oral contrast agents used during MR imaging

Our objective was to compare the efficacy of a positive and a negative oral contrast agent and to determine the optimal sequence choice for use in pelvic MR imaging.

We undertook a prospective randomized trial of 57 patients with pelvic cancer who were examined with MR imaging after oral administration of a positive contrast agent (27 patients) or a negative contrast agent (30 patients). T1- and T2-weighted breath-hold and non-breath-hold gradient-recalled echo and turbo spin-echo sequences were obtained. Using the hard-copy images, we graded filling and distention of the small bowel, bowel wall conspicuity, delineation of normal and pathologic structures, and artifacts.

Good or excellent small-bowel filling and distention was obtained in 17 patients (63%) receiving the positive agent and in 26 patients (87%) receiving the negative agent, and bowel wall conspicuity was graded good or excellent in 19 patients (70%) and 20 patients (67%), respectively. Normal and pathologic structures were better delineated with the negative agent (20 patients [74%] and 27 patients [90%], respectively; p = .02). Breath-hold gradient-recalled echo T1-weighted images were preferred for the positive agent (78%), and breath-hold T2-weighted images were preferred for the negative agent (93%). Contrast artifacts were more frequently seen with the negative agent (11% and 93%, respectively; p = .0001), and such artifacts were eliminated using T2-weighted sequences.

Both contrast agents were effective in pelvic MR imaging, but delineation of normal and pathologic structures was better with the negative agent. Gradient-recalled echo T1-weighted sequences are recommended for positive contrast agents, and breath-hold T2-weighted sequences are recommended for negative contrast agents.