Milk gets mixed reviews as a contrast agent
The idea of using milk as a contrast agent for gastrointestinal imaging has obvious appeal. Not only is it far less expensive than barium agents, it also is readily available, much easier to tolerate for patients, and it does not require a prescription. However, the lead author of a new study which found that milk compares favorably with VoLumen (E-Z-EM, Lake Success, NY), finds that not all radiologists are convinced by the results of his study.1
"We have received both positive and negative responses since publication of our work," says Chi Wan Koo, MD, a radiologist at Roosevelt-St. Luke's Hospital Center in New York City. "Some radiologists who are used to using VoLumen are still skeptical."
For example, Kenneth Hoffman, MD, the assistant chief of radiology at Kaiser Permanente in San Jose, CA, says that his staff have found milk to be only a "so-so" agent. "It is not entirely predictable or reliable in its degree of bowel distention or distribution," he says. "It also has no inherent contrast, so it really only fills the bowel lumen with fluid attenuation material, and not high attenuation material as with VoLumen." Consequently, Hoffman concludes that it really depends on what the radiologist is looking for. "If you are focused on primary bowel pathology, [whole milk] is really not optimal. If you are focused elsewhere in the abdomen and pelvis, it can be fine."
However, Woo says that pediatric radiologists are particularly interested in using milk as an alternative contrast agent in their young patients, in part because it is so much easier to tolerate than barium-based agents. This is the case with Stephano Bartoletti, clinical associate professor of radiology at the University of Pittsburgh School of Medicine. "We are exploring the issue in order to apply this technique to our children with bowel ailments such as for the evaluation of Crohn's Disease or in cases of short gut syndrome," he says. "Milk should, on average, have at least the same acceptance level as VoLumen."
Interestingly, Hoffman notes that in addition to experimenting with milk, his staff also have used plain water as a contrast agent, and he says that it can deliver "spectacular" results when looking at the bowel wall where it happens to be congregating at the time of the scan, but he points out that, as with milk, its distribution can be quite unpredictable.
Reference
- Koo CW, Shah-Patel L, Baer J, et al. Cost-effectiveness and patient tolerance of low-attenuation oral contrast material: milk versus VoLumen. Amer J Roent 2008; 190:1,307-1,313.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content