title: Computed tomography versus digital subtraction angiography for the diagnosis of obscure gastrointestinal bleeding.
abstract: OBJECTIVE
  The diagnostic yield of computed tomography angiography (CTA) compared to digital subtraction angiography (DSA) for major obscure gastrointestinal bleeding (OGIB) is not known. Aim of the study was to prospectively evaluate the diagnostic yield of CTA versus DSA for the diagnosis of major OGIB.
  
  
  METHODS
  The institutional review board approved the study and informed consent was obtained from each patient. Patients with major OGIB were prospectively enrolled to undergo both CTA and DSA. Two blinded radiologists each reviewed the CTA and DSA images retrospectively and independently. Contrast material extravasation into the gastrointestinal lumen was considered diagnostic for active bleeding. Primary end point of the study was the diagnostic yield, defined as the frequency a technique identified an active bleeding or a potential bleeding lesion. The diagnostic yield of CTA and DSA were compared by McNemar's test.
  
  
  RESULTS
  24 consecutive patients (11 men; median age 64 years) were included. CTA and DSA identified an active bleeding or a potential bleeding lesion in 92% (22 of 24 patients; 95% CI 72%-99%) and 29% (7 of 24 patients; 95% CI 12%-49%) of patients, respectively (p<0.001). CTA and DSA identified an active bleeding in 42% (10 of 24; 95% CI 22%-63%) and 21% (5 of 24; 95% CI 7%-42%) of patients, respectively (p=0.06).
  
  
  CONCLUSIONS
  Due to the lower invasiveness and higher diagnostic yield CTA should be favored over DSA for the diagnosis of major OGIB.
authors.affiliation: Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, D-93053 Regensburg, Germany; Institut für klinische Radiologie, Universitätsklinikum Münster, D-48149 Münster, Germany. Electronic address: moritzwildgruber@ukmuenster.de.
authors.forename: Moritz
authors.initials: M
authors.lastname: Wildgruber
authors.affiliation: Notfallzentrum, Helios Klinikum Berlin-Buch, D-13125 Berlin, Germany.
authors.forename: Christian E
authors.initials: CE
authors.lastname: Wrede
authors.affiliation: Institut für Radiologie, Neuroradiologie und Nuklearmedizin, Krankenhaus Barmherzige Brüder, D-93049 Regensburg, Germany.
authors.forename: Niels
authors.initials: N
authors.lastname: Zorger
authors.affiliation: Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, D-93053 Regensburg, Germany.
authors.forename: René
authors.initials: R
authors.lastname: Müller-Wille
authors.affiliation: Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, D-93053 Regensburg, Germany.
authors.forename: Okka W
authors.initials: OW
authors.lastname: Hamer
authors.affiliation: Zentrum für Klinische Studien, Universitätsklinikum Regensburg, D-93053 Regensburg, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Zeman
authors.affiliation: Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, D-93053 Regensburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Stroszczynski
authors.affiliation: Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, D-93053 Regensburg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Heiss
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging*; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
keywords: Computed tomography angiography; Digital substraction angiography; Gastrointestinal bleeding