The99mTc-labeled RBC scan

Kester, Robert R.; Welch, John P.; Sziklas, John P.

doi:10.1007/bf02554077

Cited by 34 publications

(2 citation statements)

References 11 publications

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“…There is considerable disagreement over the reliability of technetium scintigraphy for localizing the site of LGIB [7][8][9][10][11][12][13][14][15][16][17][18][19]. Some studies recommend the technetium scan as the primary method of localizing LGIB [8-10, 13, 15, 19-21].…”

Section: Discussionmentioning

confidence: 99%

Investigative modalities for massive lower gastrointestinal bleeding

et al. 2002

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The objective of this study was to evaluate the efficacy of various diagnostic modalities in the assessment of patients with massive lower gastrointestinal bleeding. The charts of all patients admitted to a McGill University affiliated teaching hospital with the diagnosis of lower gastrointestinal bleeding over a 25-year period were reviewed. There were 136 patients who underwent 202 admissions. The information documented included demographics on age, gender, co-morbid disease, prescribed medications, requirements for blood transfusions, orthostatic change in blood pressure, acute drop in hematocrit (to <30%), and exclusion of upper gastrointestinal bleeding. Among the 202 admitted patients there were 116 men and 86 women), with an average age of 70 years (range 16-95 years). At least one significant medical disease was found in 93% of these patients; and 20% were on aspirin and 5% on anticoagulants at the time of diagnosis. Rigid or flexible sigmoidoscopy was performed in 68 and 18 patients, respectively, with a definitive diagnosis made in 2.9% and 11.0%, respectively. Colonoscopy was performed in 152 cases, 20 of which were incomplete; a specific diagnosis was made for 59 admissions (45%). A red blood cell or colloid scan was performed on 53 patients, with extravasation noted in 13 (24.5%); a localized site of bleeding was identified in 9 cases (17%). Angiography was performed on 31 patients with bleeding sites localized in 6 (19%). Barium enemas were completed in 85 of 92 patients, and the presumptive cause of bleeding was identified in 72% of those with a complete examination. The most common causes identified were diverticulosis in 52 patients and angiodysplasia in 14. The cause of bleeding was not detected in 48 (35%). Bleeding stopped in most patients spontaneously, with only 7 requiring operation. The average number of units transfused was 3 (range 0-26). Scintigraphy and angiography were less efficacious than colonoscopy for localizing the site and etiology of the bleeding. Despite the combination of investigative modalities, a definitive diagnosis was not made in 35% of the admitted patients. The need for operative intervention in our study was lower than in most previous reports.

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Section: Discussionmentioning

confidence: 99%

Investigative modalities for massive lower gastrointestinal bleeding

et al. 2002

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“…15 99 m Tc-labeled RBC scans can detect active and intermittent bleeding with 80–98 % sensitivity. 3,16 However, a minimum extravasated bleed volume of 3–5 mL is required for detection irrespective of the bleed rate. 17…”

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confidence: 99%

Magnetic Particle Imaging for Highly Sensitive, Quantitative, and Safe in Vivo Gut Bleed Detection in a Murine Model

et al. 2017

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Gastrointestinal (GI) bleeding causes more than 300 000 hospitalizations per year in the United States. Imaging plays a crucial role in accurately locating the source of the bleed for timely intervention. Magnetic particle imaging (MPI) is an emerging clinically translatable imaging modality that images superparamagnetic iron-oxide (SPIO) tracers with extraordinary contrast and sensitivity. This linearly quantitative modality has zero background tissue signal and zero signal depth attenuation. MPI is also safe: there is zero ionizing radiation exposure to the patient and clinically approved tracers can be used with MPI. In this study, we demonstrate the use of MPI along with long-circulating, PEG-stabilized SPIOs for rapid in vivo detection and quantification of GI bleed. A mouse model genetically predisposed to GI polyp development (Apc) was used for this study, and heparin was used as an anticoagulant to induce acute GI bleeding. We then injected MPI-tailored, long-circulating SPIOs through the tail vein, and tracked the tracer biodistribution over time using our custom-built high resolution field-free line (FFL) MPI scanner. Dynamic MPI projection images captured tracer accumulation in the lower GI tract with excellent contrast. Quantitative analysis of the MPI images show that the mice experienced GI bleed rates between 1 and 5 μL/min. Although there are currently no human scale MPI systems, and MPI-tailored SPIOs need to undergo further development and evaluation, clinical translation of the technique is achievable. The robust contrast, sensitivity, safety, ability to image anywhere in the body, along with long-circulating SPIOs lends MPI outstanding promise as a clinical diagnostic tool for GI bleeding.

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The Role of Tagged Red Blood Cell Imaging in the Localization of Gastrointestinal Bleeding

Bentley

Richardson²

1991

Arch Surg

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\s=b\The records of 162 patients who underwent technetium\x=req-\ 99m\p=n-\tagged red blood cell scans for the localization of gastrointestinal hemorrhage were studied. Ninety-eight scans were read as positive, with bleeding sites determined by a radiologist. Forty-six patients had a definitive diagnosis made by other means. Tagged scans accurately localized the site of bleeding in only 52% of cases. Analysis of the value of these tagged scans in predicting a subsequent positive angiogram indicated that there were 14 positive and 12 negative angiograms of 26 positive scans. Of the nine patients with negative scans who underwent arteriography, the arteriogram was positive in five. These data suggest that tagged red blood cell scanning is a poor diagnostic technique for the localization of gastrointestinal bleeding, and its use as a screening tool before angiography is questionable. (Arch Surg. 1991;126:821-824) I he accurate diagnosis and localization of gastrointes¬ tinal (Gl) tract bleeding has long been a difficult task for the surgeon. Acute upper Gl tract bleeding can usually be readily diagnosed by the clinical pattern confirmed by positive findings on placement of a nasogastric tube or by esophagogastroduodenoscopy. Acute lower Gl tract bleeding can be more difficult to diagnose and localize since endoscopie studies have major limitations in deter¬ mining the site of bleeding.1,2 The small bowel is a rare source of acute bleeding but is virtually unapproachable by preoperative diagnostic tests.Arteriography became the diagnostic standard for acute lower Gl tract bleeding.3,4 However, this procedure was in¬ vasive, was generally done on an emergency basis, and re¬ quired special expertise to perform. Additionally, there was a high rate of negative examination results because the pa¬ tient had apparently ceased bleeding. The use ofradioactivelabeled erythrocytes was proposed as a method of determin¬ ing whether active bleeding was occurring and as a means of determining the site of bleeding.5"8 This method has also been advocated as a means of detecting chronic bleeding. The accuracy of this test has been reported to be excellent in many centers. However, most reports were made by radi¬ ologists who had little or no clinical data about the patients and little if any outcome or follow-up information.9"12 In many hospitals in our practice locale, radiologists refuse to perform visceral arteriography for bleeding until a tagged erythrocyte study is performed.In an effort to determine the value of this procedure, we studied the results of tagged red blood cell (RBC) studies in three hospitals and correlated these findings with clin¬ ical and outcome data. It was our hypothesis that tagged RBC scintigraphy was an unreliable diagnostic technique for detecting the site of bleeding or the presence of active bleeding. PATIENTS AND METHODSAll patients undergoing radioactive-labeled RBC scanning for Gl tract blood loss were examined at three University of Louisville (Ky)-affiliated hospitals. Two of the hospitals wer...

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The99mTc-labeled RBC scan

Cited by 34 publications

References 11 publications

Investigative modalities for massive lower gastrointestinal bleeding

Investigative modalities for massive lower gastrointestinal bleeding

Magnetic Particle Imaging for Highly Sensitive, Quantitative, and Safe in Vivo Gut Bleed Detection in a Murine Model

The Role of Tagged Red Blood Cell Imaging in the Localization of Gastrointestinal Bleeding

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