[Negative endoscopy and MSCT findings in patients with acute lower gastrointestinal hemorrhage. Value of (99m)Tc erythrocyte scintigraphy].
OBJECTIVE
To evaluate the clinical use of (99m)Tc red blood cell imaging (RBC imaging) in patients presenting with acute lower gastrointestinal (GI) bleeding and negative endoscopy and multislice computed tomography (MSCT) findings.


METHODS
In 31 consecutive patients with acute lower GI bleeding in whom the endoscopy findings were negative or the procedure was not feasible, dual-phase MSCT of the abdomen was performed [collimation 4x1 mm (arterial phase), 4x2.5 mm (venous phase)]. MSCT was followed by a (99m)Tc red blood cell scan in patients in whom no active bleeding was visible by CT. Images were created within 24 h after administration of the tracer, depending on the clinical symptoms. The results of the imaging modalities were correlated with clinical course and surgical treatment.


RESULTS
In 20 of 31 patients MSCT showed no active bleeding and a (99m)Tc red blood cell scan was performed. In 8 of 20 patients RBC imaging was also negative. Of these eight patients five were stable and did not require further diagnostic work-up; in the other three bleeding persisted and these patients required surgical treatment. In 12 of 20 patients active bleeding was demonstrated using a (99m)Tc red blood cell scan. Of 12 patients with positive RBC scintigraphy findings, 8 underwent surgery, where the site of bleeding was confirmed.


CONCLUSIONS
In patients with acute lower GI bleeding with negative or nondiagnostic endoscopy or MSCT findings, (99m)Tc red blood cell imaging is a useful tool in an emergency algorithm, improving the overall bleeding detection rate.
Diehl
S J
SJ
Institut für Klinische Radiologie am Universitätsklinikum Mannheim, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim. steffen.diehl@rad.ma.uni-heidelberg.de
Ko
H S
HS
Dominguez
E
E
Kaare Tesdal
I
I
Kähler
G
G
Böhm
C
C
Düber
C
C
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal; D004912:Erythrocytes / Q000000981:diagnostic imaging*; D005188:False Negative Reactions; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D041741:Lower Gastrointestinal Tract / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013667:Technetium; D014057:Tomography, X-Ray Computed
D019275:Radiopharmaceuticals; D013667:Technetium