title: Lower gastrointestinal bleeding: role of 64-row computed tomographic angiography in diagnosis and therapeutic planning.
abstract: OBJECTIVE
  To determine the value of computed tomographic angiography (CTA) for diagnosis and therapeutic planning in lower gastrointestinal (GI) bleeding.
  
  
  METHODS
  Sixty-three consecutive patients with acute lower GI bleeding underwent CTA before endovascular or surgical treatment. CTA was used to determine whether the lower GI bleeding was suitable for endovascular treatment, surgical resection, or conservative treatment in each patient. Treatment planning with CTA was compared with actual treatment decisions or endovascular or surgical treatment that had been carried out in each patient based on CTA findings.
  
  
  RESULTS
  64-row CTA detected active extravasation of contrast material in 57 patients and six patients had no demonstrable active bleeding, resulting in an accuracy of 90.5% in the detection of acute GI bleeding (57 of 63). In three of the six patients with no demonstrable active bleeding, active lower GI bleeding recurred within one week after CTA, and angiography revealed acute bleeding. The overall location-based accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection of GI bleeding by 64-row CTA were 98.8% (249 of 252), 95.0% (57 of 60), 100% (192 of 192), 100% (57 of 57), and 98.5% (192 of 195), respectively. Treatment planning was correctly established on the basis of 64-row CTA with an accuracy, sensitivity, specificity, PPV and NPV of 98.4% (248 of 252), 93.3% (56 of 60), 100% (192 of 192), 100% (56 of 56), and 97.5% (192 of 196), respectively, in a location-based evaluation.
  
  
  CONCLUSIONS
  64-row CTA is safe and effective in making decisions regarding treatment, without performing digital subtraction angiography or surgery, in the majority of patients with lower GI bleeding.
authors: Jian-Zhuang Ren, Meng-Fan Zhang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
authors: Jian-Zhuang
authors: JZ
authors: Ren
authors: Jian-Zhuang Ren, Meng-Fan Zhang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
authors: Meng-Fan
authors: MF
authors: Zhang
authors: Jian-Zhuang Ren, Meng-Fan Zhang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
authors: Ai-Mei
authors: AM
authors: Rong
authors: Jian-Zhuang Ren, Meng-Fan Zhang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
authors: Xiang-Jie
authors: XJ
authors: Fang
authors: Jian-Zhuang Ren, Meng-Fan Zhang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
authors: Kai
authors: K
authors: Zhang
authors: Jian-Zhuang Ren, Meng-Fan Zhang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
authors: Guo-Hao
authors: GH
authors: Huang
authors: Jian-Zhuang Ren, Meng-Fan Zhang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
authors: Peng-Fei
authors: PF
authors: Chen
authors: Jian-Zhuang Ren, Meng-Fan Zhang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
authors: Zhao-Yang
authors: ZY
authors: Wang
authors: Jian-Zhuang Ren, Meng-Fan Zhang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
authors: Xu-Hua
authors: XH
authors: Duan
authors: Jian-Zhuang Ren, Meng-Fan Zhang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
authors: Xin-Wei
authors: XW
authors: Han
authors: Jian-Zhuang Ren, Meng-Fan Zhang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
authors: Yan-Jie
authors: YJ
authors: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China; D004621:Embolization, Therapeutic; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D055815:Young Adult
keywords: Computed tomography angiography; Digital subtraction angiography; Embolization; Gastrointestinal bleeding; Surgical resection