Bowel preparation in MRI for detection of endometriosis: Comparison of the effect of an enema, no additional medication and intravenous butylscopolamine on image quality

Isabeau A. Ciggaar, Ciggaar IA, Onno D. F. Henneman, Henneman ODF, Stanley Oei, Stanley A Oei, Oei SA, Inge J S M L Vanhooymissen, Vanhooymissen IJSML, Mathijs D. Blikkendaal, Blikkendaal MD, Shandra Bipat, Bipat S
European journal of radiology · 2022 · vol. 149 , pp. 110222 · doi:10.1016/j.ejrad.2022.110222 · PMID:35217249 · W4212856672
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-12 ⓘ

Intravenous butylscopolamine improved small bowel and rectosigmoid delineation compared to bisacodyl, which was better than no preparation, but bisacodyl caused rectal wall edema.

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This retrospective study compared three bowel-preparation strategies to reduce bowel motion during pelvic MRI in 95 consecutive patients: fasting with a bisacodyl enema, no additional medication, or intravenous butylscopolamine, assessing visual image quality of pelvic structures using a 3-point delineation scale and evaluating rectal wall edema as a secondary endpoint. Interobserver agreement varied, and diagnostic odds ratios indicated that butylscopolamine improved rectal and sigmoid delineation versus bisacodyl, while bisacodyl improved rectosigmoid delineation versus no medication; small-bowel delineation was significantly better with butylscopolamine than with bisacodyl. The study also found that bisacodyl was associated with significantly higher odds of rectal wall edema than the other protocols, while delineation of other assessed structures did not significantly differ. This paper is centrally about endometriosis — it specifically examines bowel-preparation effects on pelvic MRI image quality for detection of endometriosis, with imaging quality outcomes relevant to identifying endometriosis-associated pelvic structures.

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Abstract

PurposeTo compare the effect of three different patient preparation strategies for reducing bowel motion on image quality in pelvic MRI.MethodsRetrospective study in which 95 consecutive patients undergoing pelvic MRI were subdivided based on preparation type for reduction of bowel motion: group 1 (N = 31) fasted 4 h and applied an enema (Bisacodyl 10 mg); group 2 (N = 32) received no medication; group 3 (N = 32) received intravenous butylscopolamine (Buscopan® 50 mg). Image quality was reviewed by visual assessment of delineation (3-point-scale) of pelvic structures: uterus, adnexa, bladder, rectum, sigmoid, uterosacral ligaments, round ligaments and small bowel. As secondary endpoint the presence of rectal wall edema was evaluated. Interobserver agreement was calculated, as well as relative diagnostic odds ratios (RDOR) for the protocols to provide an outcome in the best delineation category.ResultsInterobserver agreement proportions varied from 0.48 to 1.00. The rectum and sigmoid colon respectively have a 5.4 and 2.6 RDOR when butylscopolamine is applied compared to Bisacodyl (P = 0.051; P = 0.008), and a 4.2 and 5.7 times higher RDOR with Bisacodyl preparation compared to no medical preparation (P = 0.006; P < 0.01). Small bowel delineation was significantly better with butylscopolamine compared to Bisacodyl (P = 0.007). There was no significant difference in delineation of the other structures between protocols. There is a significant higher chance of observing rectal wall edema with Bisacodyl compared to the other protocols (both P < 0.001).ConclusionsButylscopolamine provides better delineation of the small bowel and rectosigmoid compared to Bisacodyl, which in turn, provides better delineation of the rectosigmoid compared to no medication. Moreover, Bisacodyl causes rectal wall edema in the majority of cases.
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Abstract

Purpose: To compare the effect of three different patient preparation strategies for reducing bowel motion on image quality in pelvic MRI. Methods: Retrospective study in which 95 consecutive patients undergoing pelvic MRI were subdivided based on preparation type for reduction of bowel motion: group 1 (N = 31) fasted 4 h and applied an enema (Bisacodyl 10 mg); group 2 (N = 32) received no medication; group 3 (N = 32) received intravenous butylscopolamine (Buscopan® 50 mg). Image quality was reviewed by visual assessment of delineation (3-point-scale) of pelvic structures: uterus, adnexa, bladder, rectum, sigmoid, uterosacral ligaments, round ligaments and small bowel. As secondary endpoint the presence of rectal wall edema was evaluated. Interobserver agreement was calculated, as well as relative diagnostic odds ratios (RDOR) for the protocols to provide an outcome in the best delineation category. Results: Interobserver agreement proportions varied from 0.48 to 1.00. The rectum and sigmoid colon respectively have a 5.4 and 2.6 RDOR when butylscopolamine is applied compared to Bisacodyl (P = 0.051; P = 0.008), and a 4.2 and 5.7 times higher RDOR with Bisacodyl preparation compared to no medical preparation (P = 0.006; P < 0.01). Small bowel delineation was significantly better with butylscopolamine compared to Bisacodyl (P = 0.007). There was no significant difference in delineation of the other structures between protocols. There is a significant higher chance of observing rectal wall edema with Bisacodyl compared to the other protocols (both P < 0.001). Conclusions: Butylscopolamine provides better delineation of the small bowel and rectosigmoid compared to Bisacodyl, which in turn, provides better delineation of the rectosigmoid compared to no medication. Moreover, Bisacodyl causes rectal wall edema in the majority of cases. | Original language | English | |---|---| | Article number | 110222 | | Journal | European journal of radiology | | Volume | 149 | | DOIs | | | Publication status | Published - 1 Apr 2022 |

Keywords

- Bowel Preparation - Diagnostic imaging - Endometriosis - Magnetic Resonance Imaging Fingerprint Dive into the research topics of 'Bowel preparation in MRI for detection of endometriosis: Comparison of the effect of an enema, no additional medication and intravenous butylscopolamine on image quality'. Together they form a unique fingerprint.Cite this - APA - Author - BIBTEX - Harvard - Standard - RIS - Vancouver

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Condition tags

endometriosis

MeSH descriptors

Butylscopolammonium Bromide Endometriosis Endometriosis Cathartics Enema Enema Female Humans Magnetic Resonance Imaging Magnetic Resonance Imaging Retrospective Studies

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