As described in the previous chapter, preparing the colon is one of the prerequisites to perform CT colonography adequately. The option of an intensive preparation to obtain a colon as clean and dry as possible has been approved in a consensus statement developed by several experts in CT colonography (Barish et al. 2005). However, although recently published, this consensus statement was already

Stedelijk Ziekenhuis, Department of Radiology, Bruggesteen-weg 90, 8800 Roeselare, Belgium developed back in 2003 shortly before the publication of the study by Pickhardt et al. (2003) in the New England Journal of Medicine. Since then opinion might have changed. Theoretically an intensive preparation should produce the best performance of polyp detection. Indeed, in a well distended, clean and dry colon, conspicuity of tumoral lesions should be at its best. However, this expectation has not been accomplished in some recent multi-centre trials. Two recently published large multi-centre studies obtained very disappointing results of polyp detection using a regular preparation (Cotton et al. 2004; Rockey et al. 2005). Of the many drawbacks these trials have been afflicted with, the lack of faecal tagging, was considered a major shortcoming (Ferrucci 2005a and author reply Ferrucci 2005b). Furthermore, to date the best results of polyp detection have been obtained in a large average-risk population of 1233 patients, using a preparation based on faecal tagging by Pickhardt et al. (2003). In this way, faecal tagging is an appealing technique and is becoming the preparation of choice to perform CT colonography (van Dam et al. 2004; Ferrucci 2005a,b).

The purpose of this chapter is: 1) to explain what faecal tagging is; 2) to demonstrate why this particular type of preparation is important; 3) to explain how faecal tagging is performed at our institution; 4) to show imaging findings.

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