Localizing Acute Lower Gastrointestinal Hemorrhage: CT Angiography Versus Tagged RBC Scintigraphy.
OBJECTIVE
Lower gastrointestinal hemorrhage is a common cause of hospitalization and has substantial associated morbidity and financial cost. CT angiography (CTA) is emerging as an alternative to (99m)Tc-labeled RBC scintigraphy (RBC scintigraphy) for the localization of acute lower gastrointestinal bleeding (LGIB); however, data on comparative efficacy are scant. The aim of this study was to assess the utility of CTA compared with RBC scintigraphy in the overall evaluation and management of acute LGIB.


METHODS
We retrospectively reviewed images from all CTA examinations performed for suspected acute LGIB at our tertiary care hospital from January 2010 through November 2011. The comparison group was determined by retrospective review of twice the number of RBC scintigraphic scans consecutively obtained from June 2008 to November 2011 for the same indication. All CTA and RBC scintigraphic scans were reviewed for accurate localization of the site and source of suspected active LGIB.


RESULTS
In total, 45 CTA and 90 RBC scintigraphic examinations were performed during the study period. Seventeen (38%) CTA scans showed active gastrointestinal bleeding compared with 34 (38%) RBC scintigraphic scans (p = 1.000). However, the site of bleeding was accurately localized on 24 (53%) CTA scans. This proportion was significantly greater than the proportion localized on RBC scintigraphic scans (27 [30%]) (p = 0.008). There were no significant differences between the two groups in average hospital length of stay, blood transfusion requirement, incidence of acute kidney injury, or in-hospital mortality.


CONCLUSIONS
Both CTA and RBC scintigraphy can be used to identify active bleeding in 38% of cases. However, the site of bleeding is localized with CTA in a significantly higher proportion of studies.
1 Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, 8E, Boston, MA 02215.
Joseph D
JD
Feuerstein
1 Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, 8E, Boston, MA 02215.
Gyanprakash
G
Ketwaroo
1 Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, 8E, Boston, MA 02215.
Sumeet K
SK
Tewani
1 Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, 8E, Boston, MA 02215.
Antonio
A
Cheesman
1 Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, 8E, Boston, MA 02215.
Juan
J
Trivella
2 Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Vassillios
V
Raptopoulos
1 Department of Medicine, Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, 8E, Boston, MA 02215.
Daniel A
DA
Leffler
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000072226:Computed Tomography Angiography / Q000379:methods*; D003287:Contrast Media; D004912:Erythrocytes; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging*; D006801:Humans; D007472:Iohexol; D008297:Male; D011877:Radionuclide Imaging / Q000379:methods*; D012189:Retrospective Studies
D003287:Contrast Media; D007472:Iohexol
CT; angiography; lower gastrointestinal bleeding; tagged RBC scintigraphy