Accuracy and efficacy of nuclear scintigraphy for the detection of gastrointestinal bleeding.
OBJECTIVE
To determine the accuracy and cost-effectiveness of nuclear scintigraphy for the diagnosis and localization of gastrointestinal (GI) bleeding and to determine whether nuclear scintigraphy accurately predicts the results of angiography.


METHODS
Retrospective chart review. The following data were obtained from the medical records: age; diagnosis before scintigraphy; duration of bleeding; hemoglobin and hematocrit values; number and duration of blood transfusions; results of angiography and GI endoscopy; location of bleeding as determined by angiography, endoscopy, and nuclear scintigraphy; treatment received by patients; actual site of bleeding as documented in the medical record; and outcome of treatment.


METHODS
Community hospital in a city with a population of approximately 100,000 and a catchment area of approximately 500,000.


METHODS
One hundred fifty-five patients undergoing 161 nuclear scintigraphic examinations because of GI bleeding between January 1, 1989, and December 31, 1992.


METHODS
Diagnosis and location of GI bleeding as determined by nuclear scintigraphy and angiography and actual site of GI bleeding as confirmed by operative intervention or endoscopy.


RESULTS
Of 114 scintigraphic examinations for which the diagnosis and localization of GI bleeding were definite, results were positive in 56 (49.1%); of these 56, a definite location of the bleeding was shown in 51 cases (91.1%), and the bleeding was localized to its exact site in 22 cases (19.3%). Of the scintigraphic examinations for which results were positive, results of angiograms were positive in 7 cases, which gives nuclear scintigraphy a 39% positive predictive value for angiography.


CONCLUSIONS
The routine use of nuclear scintigraphy is neither accurate nor cost-effective for determining the site of GI bleeding in the community hospital.
Garofalo
T E
TE
Department of Surgery, Northeastern Ohio Universities College of Medicine, Rootstown, USA.
Abdu
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies