Oral CT Contrast Agents: What's New and Why, From the AJR Special Series on Contrast Media.

Current CT oral contrast agents improve the conspicuity and confidence for bowel and peritoneal findings in many clinical scenarios, particularly for outpatient and oncologic abdominopelvic imaging. Yet, existing positive and neutral oral contrast agents may diminish the detectability of certain radiologic findings, frequently in the same scans in which the oral contrast agent improves the detectability of other findings. With ongoing improvements in CT technology, particularly multi-energy CT, opportunities are opening for new types of oral contrast agents to further improve anatomic delineation and disease detection using CT. The CT signal of new dark oral contrast agents and of new high-Z oral contrast agents promise to combine the strengths of both positive and neutral oral CT contrast agents by providing distinct CT appearances in comparison with bodily tissues, iodinated IV contrast agents, and other classes of new CT contrast agents. High-Z oral contrast agents will unlock previously inaccessible capabilities of multi-energy CT, particularly photon-counting detector CT, for differentiating simultaneously administered IV and oral contrast agents; this technique will allow generation of rich 3D, intuitive, perfectly co-registered, high-resolution image sets with individual contrast-agent "colors" that provide compelling clarity for intertwined intraabdominal anatomy and disease processes.