Revisiting Oral Barium Sulfate Contrast Agents

Oral contrast agents used during CT colonography (CTC) are valuable and may reduce false positive and false negative detections due to stool and residual fluid. Electronic cleansing algorithms are feasible, and oral contrast agents can eliminate the CTC requirement for a clean colon. Recent work shows oral contrast frequently adheres to polyps, with a preference for those with villous histology, a characteristic of advanced polyps. This finding encourages the development of contrast agents that highlight polyps at greatest risk for progression to malignancy. Our review summarizes numerous aspects of oral barium sulfate contrast agents as well as tests to assess adherence and coating ability of the agents, offering arenas to explore and tools for evaluation.