Multidetector CT Angiography in Acute Gastrointestinal Bleeding: Why, When, and How

Abstract

Acute gastrointestinal (GI) bleeding remains an important cause of emergency hospital admissions, with substantial related morbidity and mortality. Bleeding may relate to the upper or lower GI tract, with the dividing anatomic landmark between these two regions being the ligament of Treitz. The widespread availability of endoscopic equipment has had an important effect on the rapid identification and treatment of the bleeding source. However, the choice of upper or lower GI endoscopy is largely dictated by the clinical presentation, which in many cases proves misleading. Furthermore, there remains a large group of patients with negative endoscopic results or failed endoscopy, in whom additional techniques are required to identify the source of GI bleeding. Multidetector computed tomography (CT) with its speed, resolution, multiplanar techniques, and angiographic capabilities allows excellent visualization of both the small and large bowel. Multiphasic multidetector CT allows direct demonstration of bleeding into the bowel and is helpful in the acute setting for visualization of the bleeding source and its characterization. Thus, multidetector CT angiography provides a time-efficient method for directing and planning therapy for patients with acute GI bleeding. The additional information provided by multidetector CT angiography before attempts at therapeutic angiographic procedures leads to faster selective catheterization of bleeding vessels, thereby facilitating embolization. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.313105206/-/DC1.

Assessment of internal mammary artery injury after blunt chest trauma: a literature review

“…In addition, multidetector CT angiography provides a timeefficient method for directing and planning therapy for patients with acute bleeding. The additional information provided by multidetector CT angiography before attempts at therapeutic angiographic procedures leads to faster selective catheterization of bleeding vessels, thereby facilitating embolization (Geffroy et al, 2011). However, digital subtraction angiography has long been the gold standard for the detection of active bleeding in patients.…”

Hepatic artery pseudoaneurysm as a cause of gastrointestinal system bleeding: A case report with a brief review of the literature

“…A multi-slice angiographic examination with CT can be accurately utilized for determining the source of gastrointestinal bleeding, especially when conventional endoscopic studies fail to do so (14). Likewise, in our case, the upper gastrointestinal system endoscopy failed to show the source of bleeding in our patient, but CT imaging successfully detected the pseudoaneurysm and also guided the conventional angiographic intervention.…”

iPad-based primary 2D reading of CT angiography examinations of patients with suspected acute gastrointestinal bleeding: preliminary experience

“…CTA is now considered the mainstay for ANVGIB diagnosis owing to its high diagnostic accuracy in detection of acute arterial bleeding, thus helping to optimize treatment planning. [8][9][10] Digital subtraction angiography (DSA) followed by transcatheter embolization of the bleeding source is …”

“…CTA is now considered the mainstay for ANVGIB diagnosis owing to its high diagnostic accuracy in detection of acute arterial bleeding, thus helping to optimize treatment planning. [8][9][10] Digital subtraction angiography (DSA) followed by transcatheter embolization of the bleeding source is increasingly recommended as the most appropriate treatment of ANVGIB and should be carried out as soon as possible to stop the bleeding, minimize the chance of bleeding recurrence and possibly improve the patient's outcome. The feasibility of the endovascular treatment is established based on the patient's clinical parameters and vascular anatomy and should be assessed by dedicated vascular interventional radiologists owing to its invasiveness and its potential complications.…”

“…The feasibility of the endovascular treatment is established based on the patient's clinical parameters and vascular anatomy and should be assessed by dedicated vascular interventional radiologists owing to its invasiveness and its potential complications. [8][9][10][11][12][13][14] However, such specialists are not always physically available in every hospital unit on a 24/7 basis, making prompt remote consultation of CTA examinations by a vascular interventional radiologist a vital issue. In this scenario, remote tablet-based preliminary 2D reading of CTA studies of patients with suspected ANVGIB by on-call interventional radiologists could be a time-saving and costeffective solution for the management of such patients.…”