title: Evaluation of dual-phase multi-detector-row CT for detection of intestinal bleeding using an experimental bowel model.
abstract: To evaluate dual-phase multi-detector-row computed tomography (MDCT) in the detection of intestinal bleeding using an experimental bowel model and varying bleeding velocities. The model consisted of a high pressure injector tube with a single perforation (1 mm) placed in 10-m-long small bowel of a pig. The bowel was filled with water/contrast solution of 30-40 HU and was incorporated in a phantom model containing vegetable oil to simulate mesenteric fat. Intestinal bleeding in different locations and bleeding velocities varying from zero to 1 ml/min (0.05 ml/min increments, constant bleeding duration of 20 s) was simulated. Nineteen complete datasets in arterial and portal-venous phase using increasing bleeding velocities, and seven negative controls were measured using a 64 MDCT (3-mm slice thickness, 1.5-mm reconstruction increment). Three radiologists blinded to the experimental settings evaluated the datasets in a random order. The likelihood for intestinal bleeding was assessed using a 5-point scale with subsequent ROC analysis. The sensitivity to detect bleeding was 0.44 for a bleeding velocity of 0.10-0.50 ml/min and 0.97 for 0.55-1.00 ml/min. The specificity was 1.00. The area under the curve was calculated to be 0.73, 0.88 and 0.89 for reader 1, 2 and 3, respectively. Dual-phase MDCT provides high sensitivity and specificity in the detection of intestinal bleeding with bleeding velocities of 0.5-1.0 ml/min. Therefore, MDCT should be considered as a primary diagnostic technique in the management of patients with suspected intestinal bleeding.
authors.affiliation: Department of Radiology, Technische Universität München, Munich, Germany. dobritz@roe.med.tum.de
authors.forename: Martin
authors.initials: M
authors.lastname: Dobritz
authors.forename: Heinz-Peter
authors.initials: HP
authors.lastname: Engels
authors.forename: Armin
authors.initials: A
authors.lastname: Schneider
authors.forename: Hinrich
authors.initials: H
authors.lastname: Wieder
authors.forename: Hubertus
authors.initials: H
authors.lastname: Feussner
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Rummeny
authors.forename: Jens C
authors.initials: JC
authors.lastname: Stollfuss
mesh_terms: D000792:Angiography / Q000379:methods; D000818:Animals; D003287:Contrast Media / Q000494:pharmacology; D003952:Diagnostic Imaging / Q000379:methods*; D006470:Hemorrhage; D007410:Intestinal Diseases / Q000175:diagnosis* / Q000473:pathology; D007421:Intestine, Small / Q000473:pathology*; D015588:Observer Variation; D019047:Phantoms, Imaging; D012372:ROC Curve; D015203:Reproducibility of Results; D013552:Swine; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014867:Water / Q000737:chemistry
chemical_list: D003287:Contrast Media; D014867:Water