Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi-detector row helical CT.
OBJECTIVE
To prospectively evaluate accuracy of arterial phase multi-detector row helical computed tomography (CT) for detection and localization of acute massive gastrointestinal (GI) bleeding, with angiography as reference standard.


METHODS
Institutional review board approved this study; written informed consent was obtained from each patient or patient's family after procedures, including radiation dose, were explained. Twenty-six consecutive patients (17 men, nine women; age range, 18-89 years) had acute massive GI bleeding (defined as requirement of transfusion of at least 4 units of blood during 24 hours in the hospital or as hypotension with systolic blood pressure <90 mm Hg) and underwent arterial phase multi-detector row CT before angiography. Scans were obtained during arterial phase to identify extravasation of contrast material with attenuation greater than 90 HU within bowel lumen; this finding was considered diagnostic for active GI bleeding. Presence of contrast medium extravasation in each anatomic location was recorded. Sensitivity, specificity, positive and negative predictive values, and accuracy of multi-detector row CT for detection of acute GI bleeding were assessed. Accuracy for localization of acute GI bleeding was assessed by comparing locations of active bleeding at both multi-detector row CT and angiography in each patient who had active bleeding.


RESULTS
Arterial phase multi-detector row CT depicted extravasation of contrast material in 21 of 26 patients. Overall location-based sensitivity, specificity, accuracy, and positive and negative predictive values of multi-detector row CT for detection of GI bleeding were 90.9% (20 of 22), 99% (107 of 108), 97.6% (127 of 130), 95% (20 of 21), and 98% (107 of 109), respectively. Overall patient-based accuracy of multi-detector row CT for detection of acute GI bleeding was 88.5% (23 of 26). The location of contrast material extravasation on multi-detector row CT scans corresponded exactly to that of active bleeding on angiograms in all patients with contrast medium extravasation at both multi-detector row CT and angiography.


CONCLUSIONS
Arterial phase multi-detector row CT is accurate for detection and localization of bleeding sites in patients with acute massive GI bleeding.
Department of Radiology, Chonnam National University Hospital, Chonnam National University Medical School, 8 Hak-dong, Dong-gu, Gwangju 501-757, Republic of Korea. radyoon@chonnam.ac.kr
Woong
W
Yoon
Yong Yeon
YY
Jeong
Sang Soo
SS
Shin
Hyo Soon
HS
Lim
Sang Gook
SG
Song
Nam Gyu
NG
Jang
Jae Kyu
JK
Kim
Heoung Keun
HK
Kang
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D036542:Tomography, Spiral Computed