The Role of Nuclear Medicine in the Detection of Acute Gastrointestinal Bleeding

Howarth, Douglas M.

doi:10.1053/j.semnuclmed.2005.11.001

Cited by 121 publications

(57 citation statements)

References 91 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A study by Howarth of 86 patients with positive Tc99m-labeled red blood cell scintigraphy suggested that this test can be used to predict which patients will have detectable bleeding on angiography based on the presence or ab- sence of a scintigraphic "blush" seen within the first 2 min of the study (10). He reported positive and negative predictive values of 75% and 93%, respectively, which allows greater selection of patients who should undergo angiography.…”

Section: Discussionmentioning

confidence: 99%

“…He reported positive and negative predictive values of 75% and 93%, respectively, which allows greater selection of patients who should undergo angiography. The overall predictive values and clinical utility, however, are likely to be considerably lower in practice because of the inclusion of patients who are negative on Tc99m-labeled red blood cell scintigraphy (10).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Mesenteric angiography results in gastrointestinal tract hemorrhages: single center experience

Peynircioğlu

Erkus²,

Çil³

et al. 2010

Diagn Interv Radiol

View full text Add to dashboard Cite

368G astrointestinal (GI) bleeding is one of the major causes of morbidity and mortality, and the incidence of hospital admittance for GI bleeding is 120 per 100 000 cases. Gastrointestinal bleeding primarily occurs in the upper GI tract above the Treitz ligament; however, 15% of GI bleedings occur in the lower GI tract. Although bleeding spontaneously stops in 80% of patients, it progresses or relapses in the other 20% (1). Although endoscopy is the primary diagnostic method to detect upper GI bleeding, scintigraphy is widely used for lower GI bleeding. Sulfur colloid scintigraphy can detect a bleeding in the range of 0.05-0.1 mL/min, and scintigraphic imaging with tagged red blood cells can detect a bleeding in the range of 0.2-0.4 mL/min (2). Consistent with recent technological advances, mesenteric computed tomography angiography (CTA) is a promising diagnostic approach for the detection of GI bleeding. CTA is less invasive than catheter angiography, but it is less sensitive than scintigraphy (0.1 mL/min for scintigraphy compared to 0.35 mL/min for CTA). However, there are several important advantages to CTA, namely that it can be performed 24 h a day in a matter of seconds (using multidetector CT equipment) and it can easily localize the bleeding. In addition, CTA can detect important findings that accompany the bleeding, such as bowel wall thickness, mass, and perforation, through its cross-sectional scanning ability (3).Although the limit of detection of the GI bleeding rate using transcatheter mesenteric angiography and the conventional film cassette technique is 0.5 mL/min, in vivo studies have shown that the limit of detection using digital subtraction angiography (DSA) is 5-9 times greater than conventional systems (2). However, both radiation exposure and the side effects of the contrast media used in nuclear medicine and radiological diagnostic methods must be considered when examining patients with GI bleeding. Although transcatheter mesenteric angiography is an invasive procedure, it is used in patients with massive GI bleeding because it not only detects the bleeding, but the underlying cause can be treated in the same endovascular session. The combination of mesenteric CT angiography and catheter angiography demonstrates that radiology plays a key role in the diagnosis and treatment of GI bleeding, which is a clinical problem requiring a multidisciplinary approach. Even after taking into account the different detection limits and the advantages and disadvantages of imaging, there is currently no defined, standard approach to treat GI bleeding (2).Medical or endoscopic coagulation, transcatheter embolization and surgical resection are the treatment options for GI bleeding. Although surgical resection is the definitive treatment, its mortality and morbidity rates are between 10%-15% (4). Colonoscopy is widely used for the diagnosis of lower GI bleeding, but very few patients benefit from endoscopic treatment (5). Transcatheter embolization is widely used throughout PURPOSEThis retrospective stud...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mesenteric angiography results in gastrointestinal tract hemorrhages: single center experience

Peynircioğlu

Erkus²,

Çil³

et al. 2010

Diagn Interv Radiol

View full text Add to dashboard Cite

show abstract

“…However, the capacity of this procedure to detect a hemorrhagic site is limited when the bleeding rate is less than 1.0 mL/min (Howarth, 2006). Similar to colonoscopy, angiography can be nondiagnostic when GI blood loss is intermittent or quiescent.…”

Section: Discussionmentioning

confidence: 99%

Technological value of SPECT/CT fusion imaging for the diagnosis of lower gastrointestinal bleeding

et al. 2015

View full text Add to dashboard Cite

ABSTRACT. The aim of this study was to assess the clinical value of diagnosing and locating lower gastrointestinal (GI) bleeding using single photon emission computed tomography (SPECT)/computed tomography (CT) fusion imaging with 99mTc labeled red blood cells ( 99m Tc-RBC). Fifty-six patients with suspected lower GI bleeding received a preoperative intravenous injection of 99m Tc-RBC and each underwent planar, SPECT/CT imaging of the lower abdominal region. The location and path of lower GI bleeding were diagnosed by contrastive analysis of planar and SPECT/CT fusion imaging. Among the 56 patients selected, there were abnormalities in concentrated radionuclide activity with planar imaging in 50 patients and in SPECT/ CT fusion imaging in 52 patients. Moreover, bleeding points that were coincident with the surgical results were evident with planar imaging in 31 patients and with SPECT/CT fusion imaging in 48 patients. The diagnostic sensitivity of planar imaging and SPECT/CT fusion imaging were 89.3% (50/56) and 92.9% (52/56), respectively, and the difference Z.G. Wang et al. 14948©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 14 (4): 14947-14955 (2015) was not statistically significant (χ 2 = 0.11, P > 0.05). The corresponding positional accuracy values were 73.8% (31/42) and 92.3% (48/52), and the difference was statistically significant (χ 2 = 4.63, P < 0.05). 99mTc-RBC SPECT/CT fusion imaging is an effective, simple, and accurate method that can be used for diagnosing and locating lower GI bleeding.

show abstract

“…[19] A negative scintigraphic study is predictive of a good outcome and may be a very useful means of risk stratification in patients who do not need to be put at an unnecessary risk of emergency surgery. [26] Consistent with the above-mentioned opinion, in the present study, no patient with negative RBC scintigraphy underwent urgent surgical exploration.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18] In addition, RBC scintigraphy may be helpful in establishing the correct timing of the angiography. [19] In the present study, angiography was performed in nine patients with negative results before referral to our center. In all of these patients, RBC scintigraphies were found to be positive, and three patients underwent surgical exploration.…”

Section: Discussionmentioning

confidence: 99%

Role of red blood cell scintigraphy for determining the localization of gastrointestinal bleeding

Şanlı

Özkan²,

Kuyumcu³

et al. 2012

Ulus Travma Acil Cerrahi Derg

View full text Add to dashboard Cite

AMAÇGastrointestinal sistem (GİS) kanamalarında kanama odağı-nın saptanmasında, Tc-99m ile işaretli eritrosit (RBC) sintigrafisinin rolü klinik deneyimlerimiz ışığında değerlendirildi. GEREÇ VE YÖNTEM1995-2010 yılları arasında GİS kanaması odağının belirlenmesi amacıyla kliniğimize gönderilen 57 hasta (27 kadın, 30 erkek; ortalama yaş 43.9±24; dağılım 1-91 yıl) geriye dönük olarak çalışmaya alındı. Sintigrafi öncesi hastaların 51'ine gastroskopi, 45'ine kolonoskopi, 9'una anjiyografi yapılmıştı. BULGULARRBC sintigrafisi hastaların 31'inde pozitif ve 26'sında negatifti. Pozitif sintigrafik bulgular, 19 hastada ilk bir saatlik dinamik imajlarda, 7 hastada 1-4. saatler arası statik imajlarda, 5 hastada ise 4-24. saatler arasında alınan statik imajlarda kaydedildi. Toplam 14 hasta GİS kanaması nedeniyle ameliyat edildi. On üç hastada kanama yeri RBC sintigrafisi tanısıyla doğrulandı (doğruluk: %92,8). Ameliyat edilmeyen 43 hastanın 12'sinde nedeni bilinmeyen demir eksikliği anemisi vardı ki bu hastaların tümünde sintigrafi negatif olarak sonuçlandı. Yoğun kanama bulguları olan 4 hasta medikal takip sürecinde kaybedildi, geri kalan 27 hastanın kanamaları kendiliğinden ya da konservatif tedavilerle durdu. SONUÇÇalışmamız aktif GİS kanamalarında kanama odağının belirlenmesinde sintigrafinin primer yöntem olması gerekliliğini göstermektedir. Özellikle ilk 1 saatlik dinamik görün-tüleme esnasında saptanan pozitif imajlar, kanama odağı-nın doğru yerinin saptanmasında ve cerrahi gerekliliğin belirlenmesinde yol göstericidir.Anahtar Sözcükler: Gastrointestinal kanama; işaretli eritrosit sintigrafisi; endoskopik girişimler.

show abstract

The Role of Nuclear Medicine in the Detection of Acute Gastrointestinal Bleeding

Cited by 121 publications

References 91 publications

Mesenteric angiography results in gastrointestinal tract hemorrhages: single center experience

Mesenteric angiography results in gastrointestinal tract hemorrhages: single center experience

Technological value of SPECT/CT fusion imaging for the diagnosis of lower gastrointestinal bleeding

Role of red blood cell scintigraphy for determining the localization of gastrointestinal bleeding

Contact Info

Product

Resources

About