CT colonography without cathartic preparation: positive predictive value and patient experience in clinical practice

Eur Radiol. 2012 Jun;22(6):1195-204. doi: 10.1007/s00330-011-2367-0. Epub 2012 Jan 14.


Objective: To determine the positive predictive value (PPV) for polyps ≥ 6 mm detected at CT colonography (CTC) performed without cathartic preparation, with low-dose iodine faecal tagging regimen and to evaluate patient experience.

Methods: 1920 average-risk patients underwent CTC without cathartic preparation. Faecal tagging was performed by diatrizoate meglumine and diatrizoate sodium at a total dose of 60 ml (22.2 g of iodine).The standard interpretation method was primary 3D with 2D problem solving. We calculated per-patient and per-polyp PPV in relation to size and morphology. All colonic segments were evaluated for image quality (faecal tagging, amount of liquid and solid residual faeces and luminal distension). Patients completed a questionnaire before and after CTC to assess preparation and examination experience.

Results: Per-polyp PPV for detected lesions of ≥ 6 mm, 6-9 mm, ≥ 10 mm and ≥ 30 mm were 94.3%, 93.1%, 94.7% and 98%, respectively. Per-polyp PPV, according to lesion morphology, was 94.6%, 97.3% and 85.1% for sessile, pedunculated and flat polyps, respectively. Per-patient PPV was 92.8%. Preparation without frank cathartics was reported to cause minimal discomfort by 78.9% of patients.

Conclusion: CTC without cathartic preparation and low-dose iodine faecal tagging may yield high PPVs for lesions ≥ 6 mm and is well accepted by patients.

Key points: • Computed tomographic colonography (CTC) without cathartic preparation is well accepted by patients • Cathartic-free faecal tagging CTC yields high positive predictive values • CTC without cathartic preparation could improve uptake of colorectal cancer screening.

MeSH terms

  • Aged
  • Cathartics
  • Colonic Polyps / diagnostic imaging*
  • Colonic Polyps / epidemiology*
  • Colonography, Computed Tomographic / statistics & numerical data*
  • Contrast Media
  • Diatrizoate Meglumine*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Observer Variation
  • Prevalence
  • Reproducibility of Results
  • Risk Assessment / methods
  • Risk Factors
  • Sensitivity and Specificity
  • Spain / epidemiology


  • Cathartics
  • Contrast Media
  • Diatrizoate Meglumine