Accuracy of 99mTechnetium-labeled RBC Scintigraphy and MDCT With Gastrointestinal Bleed Protocol for Detection and Localization of Source of Acute Lower Gastrointestinal Bleeding

Awais, Muhammad; Haq, Tanveer Ul; Rehman, Abdul; Zaman, Maseeh uz; Haider, Zishan; Khattak, Yasir Jamil; Baloch, Noor Ul-Ain

doi:10.1097/mcg.0000000000000462

Cited by 17 publications

(10 citation statements)

References 34 publications

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“…As mentioned previously, CT with GIB protocol is performed for most patients with massive GIB at our institution prior to diagnostic angiography. In a previous study published in 2016, we showed that CT with GIB is superior to RBC scintigraphy in terms of detecting GIB and localizing an anatomic site [25]. Some investigators do not favor this approach due to the fear of increasing the incidence of acute kidney injury and losing precious time in performing the CT scan [14].…”

Section: Discussionmentioning

confidence: 99%

Empiric Transcatheter Arterial Embolization for Massive or Recurrent Gastrointestinal Bleeding: Ten-year Experience from a Single Tertiary Care Center

Azeemuddin¹,

Awais²,

Sayani³

et al. 2019

Cureus

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Purpose In patients with massive or recurrent gastrointestinal bleeding (GIB) which is not amenable to endoscopic therapy, angiographic interventions are often employed. We report our ten-year experience of empiric transcatheter arterial embolization (TAE) for patients with massive or recurrent GIB. Methods All patients who had undergone empiric TAE at our hospital between March 2004 and June 2015 were identified using the institutional radiology information system. A retrospective chart review was performed using a structured pro forma. Technical success rate, 30-day clinical success rate, 30-day mortality rate, and rate of procedural complications were computed. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 20. Results A total of 32 patients had undergone empiric TAE for GIB during the study period. The median age of subjects was 56 years and two-thirds of them were male (68.7%). Gastroduodenal (n=24), ileocolic (n=3), left gastric (n=2), right gastroepiploic (n=1), and branches of superior and middle rectal arteries (n=1) were embolized using microcoils (n=25), polyvinyl alcohol particles (n=25), and gelatin sponge (n=3)--either alone or in combination. Technical and 30-day clinical success rates were 96.9% (31/32) and 71.9% (23/32), respectively. The 30-day mortality rate for our cohort was 21.9% (7/32). One patient developed re-bleeding at two days after the initial procedure and required repeat embolization. Coil migration (n=3) and access site hematoma (n=1) were the observed procedural complications. Conclusion Empiric TAE can be a useful treatment option for selected patients with massive or recurrent GIB that is not amenable to endoscopic therapy.

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Section: Discussionmentioning

confidence: 99%

Empiric Transcatheter Arterial Embolization for Massive or Recurrent Gastrointestinal Bleeding: Ten-year Experience from a Single Tertiary Care Center

Azeemuddin¹,

Awais²,

Sayani³

et al. 2019

Cureus

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“…Although several recent studies have showed the utility of CTA for LGIB, the small sample size in our review precluded meaningful statistical analysis. [7][8][9][10]…”

Section: Resultsmentioning

confidence: 99%

Time to Catheter Angiography for Gastrointestinal Bleeding after Prior Positive Investigation Does Not Affect Bleed Identification

Brahmbhatt

Rao

Cantos

et al. 2020

JCIS

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Objective: To determine, time to angiography for patients with positive gastrointestinal bleeding (GIB) on prior investigation (endoscopy [ES], nuclear medicine [NM] Tc99m red blood cells (RBC) scan, or computed tomography angiography), affects angiographic bleed identification. Materials and Methods: Visceral Angiograms performed from January 2012 to August 2017 were evaluated. Initial angiograms performed for GIB were included in the study. Exclusion criteria included recent abdominal surgery or procedure (30 days), empiric embolization (embolization without visualized active bleeding), and use of vasodilators, or subsequent angiogram. Timing and results of ES, NM Tc99m RBC scan, or computed tomography angiogram and catheter angiogram were recorded. In addition, age, gender, angiogram time, anti- platelet therapy, anti-coagulation therapy, bleed location, international normalized ratio, and units of packed RBCs received in the 24 h before catheter angiography were included in the study. Results: One hundred and seventy angiograms were included in the final analysis. Forty-three angiograms resulted in the identification of an active bleed (68.9 years, and 67.4% male). All of these patients were embolized successfully. One hundred and twenty-seven angiograms failed to identify an active bleed (70.4 years, and 49.6% male). No significance was found across the two groups with respect to time from prior positive investigation. Receiver operating characteristic analysis demonstrated that units of packed RBCs received in the preceding 24 h were correlated with positive bleed identification on catheter angiography. Conclusion: Time to angiography from prior positive investigation, including ES, NM Tc99m RBC scan, or computed tomography angiogram does not correlate with positive angiographic outcomes. Increasing units of packed RBCs administered in the 24 h before angiogram do correlate with positive angiographic findings.

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“…In addition, planar radionuclide scans frequently provide inaccurate localization of the site of bleeding, which can lead to erroneous focus during subsequent transcatheter arteriography. Several recent studies of radionuclide scans have reported incorrect localization of bleeding in 10% to 33% of cases, with some of these patients subsequently undergoing wrong-site surgery [54][55][56]. In one study of cases identified as positive on planar radionuclide scan, the site of bleeding was found to be identified incorrectly on 11.5% of scans when these results were compared with those from subsequent transcatheter arteriography, and the specificity for localization of the source of bleeding was also poor with planar radionuclide scan (33.3%) compared with CTA (90.9%) [56].…”

Section: Discussion Of Procedures or Treatment By Variantmentioning

confidence: 99%

“…Several recent studies of radionuclide scans have reported incorrect localization of bleeding in 10% to 33% of cases, with some of these patients subsequently undergoing wrong-site surgery [54][55][56]. In one study of cases identified as positive on planar radionuclide scan, the site of bleeding was found to be identified incorrectly on 11.5% of scans when these results were compared with those from subsequent transcatheter arteriography, and the specificity for localization of the source of bleeding was also poor with planar radionuclide scan (33.3%) compared with CTA (90.9%) [56]. For better localization of the site of bleeding, single-photon emission computed tomography (SPECT) can be performed when planar radionuclide images demonstrate a new focus of abnormal extravascular activity that conforms to the bowel.…”

Section: Discussion Of Procedures or Treatment By Variantmentioning

confidence: 99%

ACR Appropriateness Criteria® Radiologic Management of Lower Gastrointestinal Tract Bleeding: 2021 Update

Karuppasamy

Kapoor

Fidelman

et al. 2021

Journal of the American College of Radiology

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Diverticulosis remains the commonest cause for acute lower gastrointestinal tract bleeding (GIB). Conservative management is initially sufficient for most patients, followed by elective diagnostic tests. However, if acute lower GIB persists, it can be investigated with colonoscopy, CT angiography (CTA), or red blood cell (RBC) scan. Colonoscopy can identify the site and cause of bleeding and provide

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Accuracy of 99mTechnetium-labeled RBC Scintigraphy and MDCT With Gastrointestinal Bleed Protocol for Detection and Localization of Source of Acute Lower Gastrointestinal Bleeding

Abstract: CT with GI bleed protocol was more accurate in detecting and localizing the source of acute LGIB as compared with (99M)Tc-labeled RBC scintigraphy.

Cited by 17 publications

References 34 publications

Empiric Transcatheter Arterial Embolization for Massive or Recurrent Gastrointestinal Bleeding: Ten-year Experience from a Single Tertiary Care Center

Empiric Transcatheter Arterial Embolization for Massive or Recurrent Gastrointestinal Bleeding: Ten-year Experience from a Single Tertiary Care Center

Time to Catheter Angiography for Gastrointestinal Bleeding after Prior Positive Investigation Does Not Affect Bleed Identification

ACR Appropriateness Criteria® Radiologic Management of Lower Gastrointestinal Tract Bleeding: 2021 Update

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