Did You Know #5 : The Simple Clinical Test that beats CT and MRI in Accuracy

The last few decades have seen dramatic increase in diagnosis accuracy and speed with the advent of modern radiology techniques like MRI, CT Scan and PET Scan. However, even today there are cases where simple common sense not only suffices, but even beats the hi-tech modern methods in diagnosis accuracy and costs. Here’s one such example. Read and enjoy!

Name – Poppy seed test.
Type – Clinical test.
First described in – 2001 (Yes, not all simple things are ages old)

Poppy seed test uses poppy seeds (called afim or khaskhas in Asia) to diagnose vesicointestinal fistula.

Used to diagnose
Vesico-intestinal fistula (a relatively rare dangerous situation, where a tiny connecting tract gets formed abnormally between the intestine and the urinary bladder, causing their contents to intermingle, potentially causing severe urinary infections and other fatal complications.)

The possible alternatives to this test
Magnetic Resonance Imaging (MRI), abdominopelvic CT scan, colonoscopy, urethro-cystoscopy and retrograde colonic enema.
(All of them 50 to 1000 times more expensive than poppy seed test.)

How it is done
The patient is fed 1.25 ounces of poppy seeds (Afim / khaskhas) with 12 ounces of fluid or 6 ounces of yogurt (Dahi). The patient’s urine is then collected for the next 48 hours and examined for poppy seeds. When the patient is indeed suffering from vesico-intestinal fistula, the seeds, owing to their tiny size, cross over from the guts through the connecting tract, into the bladder, and thence come out with the urine. If a poppy seed is found in the urine, the patient has a vesico-intestinal fistula.

Poppy seeds are smaller than 1 millimeter in size.

Comparative accuracy
The accuracy of this test is almost 100%, way ahead of all the other options. In a series of 49 patients who underwent surgery for colovesical fistula (vesico-intestinal fistula of the large intestine) due to sigmoid diverticulitis, the poppy seed test gave a correct diagnosis more often than abdominopelvic CT, MRI of the abdomen, cystogram, retrograde colonic enema, urethrocystoscopy, and colonoscopy.[1] In a series of 20 patients in the United States, the poppy seed test was significantly more accurate than computed tomography.[2] In these two series, respectively, sensitivity of the test was 94.6% and 100%. Because of the physical nature of the test, specificity of the test is necessarily 100%.

ShortcomingsNothing is picture perfect in the world. Poppy seed test can diagnose a vesico-intestinal fistula perfectly, but cannot tell its exact location in the body. However, in many real-life diagnosis scenarios, it does save a lot money to the patient, so the therapeutic importance.

Bottomline Common sense can sometimes save huge amounts of money that technology and infrastructure can’t; and most importantly, it costs nothing to use it!

1. Melchior S, Cudovic D, Jones J, Thomas C, Gillitzer R, Thüroff J (September 2009). “Diagnosis and surgical management of colovesical fistulas due to sigmoid diverticulitis”. The Journal of Urology 182 (3): 978–82. doi:10.1016/j.juro.2009.05.022. PMID 19616793.
2. Kwon EO, Armenakas NA, Scharf SC, Panagopoulos G, Fracchia JA (April 2008). “The poppy seed test for colovesical fistula: big bang, little bucks!”. The Journal of Urology 179 (4): 1425–7. doi:10.1016/j.juro.2007.11.085. PMID 18289575.

Original article credits
A good part of this article was taken as it is from Wikipedia, as there isn’t really much to add or subtract to the topic. We extend due thanks to the contributors who wrote, proof-read and edited the original article there.


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