Enteral Contrast Administration in Abdominal Computed Tomography: Status Quo in Germany

Abstract

Purpose

In an online survey conducted by the Gastrointestinal and Abdominal Imaging Working Group of the German Radiological Society (DRG), the current state regarding enteral contrast administration in computed tomography (CT) of the abdomen in Germany was established and critically evaluated. The results of the survey are intended to serve as a basis for expert recommendations on enteral contrast administration in abdominal CT.

Materials and methods

DRG members were invited to take part in the online survey by email, newsletter, and via the DRG online portal. The survey was available for 70 days. It comprised 61 questions on enteral contrast administration in various clinical scenarios, with an average operation approximately 10 to 15 minutes. The results were analyzed using descriptive statistical methods.

Results

1,001 radiologists completed the survey. Of the participants, 67% worked in a hospital and 33% in private practice or a medical care center. Furthermore, 52% of the participants were senior physicians or board-certified radiologists. Enteral contrast administration is being performed selectively for various indications, but with considerable differences in technique and regularity. A lack of substantial diagnostic gain, as well as time-related or organizational factors, were the main reasons cited against enteral contrast administration.

Conclusion

The results of the survey demonstrate a heterogeneous, selective, and indication-specific implementation of enteral contrast administration. There are considerable differences regarding technical implementation and realization. There is a strong desire for generally applicable recommendations along with their integration in respective SOPs.

Key Points

• Enteral contrast administration in abdominal CT is being performed very heterogeneously.

• Guidelines lack specifications regarding enteral contrast administration.

• There is a strong desire for recommendations and their implementation in relevant SOPs.

Citation Format

• Stadelmann J, Grenacher L, Juchems MS et al. Enteral Contrast Administration in Abdominal Computed Tomography: Status Quo in Germany. Rofo 2025; DOI 10.1055/a-2594-7579

Keywords

abdomen - CT - technical aspects

• References

• 1 Kirkpatrick RH, Wittenberg J, Schaffer DL. et al. Scanning techniques in computed body tomography. AJR Am J Roentgenol 1978; 130: 6-1069
• 2 González-Moreno M, Plasencia-Martínez JM, Blanco-Barrio A. et al. Is positive oral contrast material necessary for computed tomography in patients with suspected acute abdomen?. Radiología (Engl Ed) 2019; 61: 161-166
• 3 Kessner R, Barnes S, Halpern P. et al. CT for Acute Nontraumatic Abdominal Pain-Is Oral Contrast Really Required?. Acad Radiol 2017; 24: 840-845
• 4 AWMF-Regelwerk Leitlinien. Accessed February 27, 2025 at: http://www.awmf.org/leitlinien/awmf-regelwerk.html
• 5 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Magenkarzinom, Langversion 2.0, 2019 AWMF-Registernummer: 032/009OL. Accessed February 27, 2025 at: http://www.leitlinienprogramm-onkologie.de/leitlinien/magenkarzinom/
• 6 Pickhardt PJ. Positive Oral Contrast Material for Abdominal CT: Current Clinical Indications and Areas of Controversy. AJR Am J Roentgenol 2020; 215: 69-78
• 7 SurveyMonkey Inc. San Mateo, California, USA. Accessed October 23, 2024 at: http://www.surveymonkey.de
• 8 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Diagnostik und Therapie der Plattenepithelkarzinome und Adenokarzinome des Ösophagus, Langversion 4.0, 2023, AWMF-Registernummer: 021–0230L. Accessed February 27, 2025 at: https://www.leitlinienprogramm-onkologie.de/leitlinien/oesophaguskarzinom/
• 9 Onkopedia Leitlinienreport Gastrointestinale Stromatumoren (GIST), Stand 04/2024. Accessed February 27, 2025 at: http://www.onkopedia.com/de/onkopedia/guidelines
• 10 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): S3-Leitlinie Exokrines Pankreaskarzinom, Langversion 3.0, 2024, AWMF-Registernummer: 032–010OL. Accessed February 27, 2025 at: https://www.leitlinienprogramm-onkologie.de/leitlinien/pankreaskarzinom/
• 11 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Diagnostik und Therapie des Hepatozellulären Karzinoms und biliärer Karzinome, Kurzversion 5.1, 2024, AWMF-Registernummer: 032–053OL. Accessed February 27, 2025 at: https://www.leitlinienprogramm-onkologie.de/leitlinien/hcc-und-biliaere-karzinome/
• 12 S1-Leitlinie Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen, Version 1.0 – Dezember 2021 AWMF-Registernummer: 088–011. Accessed February 27, 2025 at: https://register.awmf.org/de/leitlinien/detail/088–011
• 13 S3-Leitlinie Divertikelkrankheit/Divertikulitis – Gemeinsame Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) November 2021 – AWMF-Registernummer: 021–20. Accessed February 27, 2025 at: https://register.awmf.org/de/leitlinien/detail/021–020
• 14 Deutsche Gesellschaft für Unfallchirurgie e.V.: S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung (Version 4.0) – 31.12.2022 – AWMF-Registernummer: 187–023. Accessed February 27, 2025 at: https://www.awmf.org/leitlinien/detail/l|/187–023.html
• 15 Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (Version 4.2) – living guideline März 2024 – AWMF-Registernummer:021–004. Accessed February 27, 2025 at: https://register.awmf.org/de/leitlinien/detail/021–004
• 16 Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF): Perioperatives Management bei gastrointestinalen Tumoren (POMGAT), Langversion 1.0, 2023, AWMF-Registernummer: 088–0100L. Accessed February 27, 2025 at: https://www.leitlinienprogramm-onkologie.de/leitlinien/perioperatives-management-bei-gastrointestinalen-tumoren-pomgat/
• 17 Schreyer AG, Wessling J, Grenacher L. Current Practice vs. Guideline Based Imaging in Abdominal Radiology in the German Speaking Area: Results of an Online Survey. Rofo 2016; 188: 268-279
• 18 Lee CH, Haaland B, Earnest A. et al. Use of positive oral contrast agents in abdominopelvic computed tomography for blunt abdominal injury: Meta-analysis and systematic review. Eur Radiol 2013; 23: 2513-21
• 19 Rausch VH, Weinrich JM, Schön G. et al. Accuracy of preoperative CT staging of acute colonic diverticulitis using the classification of diverticular disease (CDD) – Is there a beneficial impact of water enema and visceral obesity?. Eur J Radiol 2021; 141: 109813
• 20 Meyer S, Schmidbauer M, Wacker FK. et al. To Fill or Not to Fill? – Value of the Administration of Positive Rectal Contrast for CT Evaluation of Diverticular Disease of the Colon. Rofo 2021; 193: 804-812
• 21 Marres CCM, Engelmann EWM, Buskens CJ. et al. The importance of rectal contrast in CT assessment to detect anastomotic leakage after colorectal surgery. Colorectal Dis 2021; 23: 2466-2471
• 22 Moreno-Lopez N, Mvouama S, Bourredjem A. et al. CT scan for early diagnosis of anastomotic leak after colorectal surgery: Is rectal contrast useful?. Tech Coloproctol 2023; 27: 639-645