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Sengupta N, Kastenberg DM, Bruining DH, Latorre M, Leighton JA, Brook OR, Wells ML, Guglielmo FF, Naringrekar HV, Gee MS, Soto JA, Park SH, Yoo DC, Ramalingam V, Huete A, Khandelwal A, Gupta A, Allen BC, Anderson MA, Dane BR, Sokhandon F, Grand DJ, Tse JR, Fidler JL. The Role of Imaging for GI Bleeding: ACG and SAR Consensus Recommendations. Radiology 2024; 310:e232298. [PMID: 38441091 DOI: 10.1148/radiol.232298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Gastrointestinal (GI) bleeding is the most common GI diagnosis leading to hospitalization within the United States. Prompt diagnosis and treatment of GI bleeding is critical to improving patient outcomes and reducing high health care utilization and costs. Radiologic techniques including CT angiography, catheter angiography, CT enterography, MR enterography, nuclear medicine red blood cell scan, and technetium-99m pertechnetate scintigraphy (Meckel scan) are frequently used to evaluate patients with GI bleeding and are complementary to GI endoscopy. However, multiple management guidelines exist, which differ in the recommended utilization of these radiologic examinations. This variability can lead to confusion as to how these tests should be used in the evaluation of GI bleeding. In this document, a panel of experts from the American College of Gastroenterology and Society of Abdominal Radiology provide a review of the radiologic examinations used to evaluate for GI bleeding including nomenclature, technique, performance, advantages, and limitations. A comparison of advantages and limitations relative to endoscopic examinations is also included. Finally, consensus statements and recommendations on technical parameters and utilization of radiologic techniques for GI bleeding are provided. © Radiological Society of North America and the American College of Gastroenterology, 2024. Supplemental material is available for this article. This article is being published concurrently in American Journal of Gastroenterology and Radiology. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Citations from either journal can be used when citing this article. See also the editorial by Lockhart in this issue.
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Affiliation(s)
- Neil Sengupta
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - David M Kastenberg
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - David H Bruining
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Melissa Latorre
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Jonathan A Leighton
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Olga R Brook
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Michael L Wells
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Flavius F Guglielmo
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Haresh V Naringrekar
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Michael S Gee
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Jorge A Soto
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Seong Ho Park
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Don C Yoo
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Vijay Ramalingam
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Alvaro Huete
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Ashish Khandelwal
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Avneesh Gupta
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Brian C Allen
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Mark A Anderson
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Bari R Dane
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Farnoosh Sokhandon
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - David J Grand
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Justin R Tse
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
| | - Jeff L Fidler
- From the Department of Gastroenterology and Hepatology, University of Chicago Pritzker School of Medicine, Chicago, Ill (N.S.); Department of Gastroenterology and Hepatology (D.M.K.) and Department of Radiology (F.F.G., H.V.N.), Thomas Jefferson University Hospital, Philadelphia, Pa; Department of Gastroenterology and Hepatology (D.H.B.) and Department of Radiology (M.L.W., A.K., J.L.F.), Mayo Clinic, 200 First St SW, Rochester, MN 55905; Department of Gastroenterology and Hepatology (M.L.) and Department of Radiology (B.R.D.), NYU Langone Medical Center, New York, NY; Department of Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Ariz (J.A.L.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.S.G., M.A.A.); Department of Radiology, Boston University Medical Center, Boston, Mass (J.A.S., A.G.); Department of Radiology, Asan Medical Center, Seoul, South Korea (S.H.P.); Department of Radiology, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI (D.C.Y., D.J.G.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, William Beaumont University Hospital, Royal Oak, Mich (F.S.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (J.R.T.)
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Sengupta N, Kastenberg DM, Bruining DH, Latorre M, Leighton JA, Brook OR, Wells ML, Guglielmo FF, Naringrekar HV, Gee MS, Soto JA, Park SH, Yoo DC, Ramalingam V, Huete A, Khandelwal A, Gupta A, Allen BC, Anderson MA, Dane BR, Sokhandon F, Grand DJ, Tse JR, Fidler JL. The Role of Imaging for Gastrointestinal Bleeding: Consensus Recommendations From the American College of Gastroenterology and Society of Abdominal Radiology. Am J Gastroenterol 2024; 119:438-449. [PMID: 38857483 DOI: 10.14309/ajg.0000000000002631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 12/12/2023] [Indexed: 06/12/2024]
Abstract
Gastrointestinal (GI) bleeding is the most common GI diagnosis leading to hospitalization within the United States. Prompt diagnosis and treatment of GI bleeding is critical to improving patient outcomes and reducing high healthcare utilization and costs. Radiologic techniques including computed tomography angiography, catheter angiography, computed tomography enterography, magnetic resonance enterography, nuclear medicine red blood cell scan, and technetium-99m pertechnetate scintigraphy (Meckel scan) are frequently used to evaluate patients with GI bleeding and are complementary to GI endoscopy. However, multiple management guidelines exist which differ in the recommended utilization of these radiologic examinations. This variability can lead to confusion as to how these tests should be used in the evaluation of GI bleeding. In this document, a panel of experts from the American College of Gastroenterology and Society of Abdominal Radiology provide a review of the radiologic examinations used to evaluate for GI bleeding including nomenclature, technique, performance, advantages, and limitations. A comparison of advantages and limitations relative to endoscopic examinations is also included. Finally, consensus statements and recommendations on technical parameters and utilization of radiologic techniques for GI bleeding are provided.
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Affiliation(s)
- Neil Sengupta
- Department of Gastroenterology and Hepatology, University of Chicago, Chicago, Illinois, USA
| | - David M Kastenberg
- Department of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David H Bruining
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Melissa Latorre
- Department of Gastroenterology and Hepatology, New York University Langone Health, New York City, New York, USA
| | - Jonathan A Leighton
- Department of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Michael L Wells
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Haresh V Naringrekar
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jorge A Soto
- Department of Radiology, Boston University, Boston, Massachusetts, USA
| | - Seong Ho Park
- Department of Radiology, Asan Medical Center, Seoul, South Korea
| | - Don C Yoo
- Department of Radiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Vijay Ramalingam
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Alvaro Huete
- Department of Radiology, Pontifical Catholic University of Chile, Santiago, Chile
| | | | - Avneesh Gupta
- Department of Radiology, Boston University, Boston, Massachusetts, USA
| | - Brian C Allen
- Department of Radiology, Duke University, Durham, North Carolina, USA
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bari R Dane
- Department of Radiology, New York University Langone Health, New York City, New York, USA
| | - Farnoosh Sokhandon
- Department of Radiology, William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - David J Grand
- Department of Radiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Justin R Tse
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
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Nehra AK, Dane B, Yeh BM, Fletcher JG, Leng S, Mileto A. Dual-Energy, Spectral and Photon Counting Computed Tomography for Evaluation of the Gastrointestinal Tract. Radiol Clin North Am 2023; 61:1031-1049. [PMID: 37758355 DOI: 10.1016/j.rcl.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
The use of dual-energy computed tomography (CT) allows for reconstruction of energy- and material-specific image series. The combination of low-energy monochromatic images, iodine maps, and virtual unenhanced images can improve lesion detection and disease characterization in the gastrointestinal tract in comparison with single-energy CT.
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Affiliation(s)
- Avinash K Nehra
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Bari Dane
- Department of Radiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Achille Mileto
- Department of Radiology, Virginia Mason Medical Center, 1100 9th Avenue, Seattle, WA 98101, USA
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Rajiah PS, Kambadakone A, Ananthakrishnan L, Sutphin P, Kalva SP. Vascular Applications of Dual-Energy Computed Tomography. Radiol Clin North Am 2023; 61:1011-1029. [PMID: 37758354 DOI: 10.1016/j.rcl.2023.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Dual- or multi-energy CT imaging provides several advantages over conventional CT in the context of vascular imaging. Specific advantages include the use of low-energy virtual monoenergetic images (VMIs) to boost iodine attenuation to salvage suboptimal enhanced studies, perform low-contrast material dose studies, and increase conspicuity of small vessels and lesions. Alternatively, high-energy VMIs reduce artifacts caused by some metals, endoprosthesis, calcium blooming, and beam hardening. Virtual non-contrast (VNC) images reduce radiation dose by eliminating the need for a true non-contrast acquisition in multiphasic CT studies. Iodine maps can be used to evaluate perfusion of tissues and lesions.
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Affiliation(s)
- Prabhakar S Rajiah
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA.
| | | | | | - Patrick Sutphin
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Sanjeeva P Kalva
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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5
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Dane B, Gupta A, Wells ML, Anderson MA, Fidler JL, Naringrekar HV, Allen BC, Brook OR, Bruining DH, Gee MS, Grand DJ, Kastenberg D, Khandelwal A, Sengupta N, Soto JA, Guglielmo FF. Dual-Energy CT Evaluation of Gastrointestinal Bleeding. Radiographics 2023; 43:e220192. [PMID: 37167088 DOI: 10.1148/rg.220192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Gastrointestinal (GI) bleeding is a potentially life-threatening condition accounting for more than 300 000 annual hospitalizations. Multidetector abdominopelvic CT angiography is commonly used in the evaluation of patients with GI bleeding. Given that many patients with severe overt GI bleeding are unlikely to tolerate bowel preparation, and inpatient colonoscopy is frequently limited by suboptimal preparation obscuring mucosal visibility, CT angiography is recommended as a first-line diagnostic test in patients with severe hematochezia to localize a source of bleeding. Assessment of these patients with conventional single-energy CT systems typically requires the performance of a noncontrast series followed by imaging during multiple postcontrast phases. Dual-energy CT (DECT) offers several potential advantages for performing these examinations. DECT may eliminate the need for a noncontrast acquisition by allowing the creation of virtual noncontrast (VNC) images from contrast-enhanced data, affording significant radiation dose reduction while maintaining diagnostic accuracy. VNC images can help radiologists to differentiate active bleeding, hyperattenuating enteric contents, hematomas, and enhancing masses. Additional postprocessing techniques such as low-kiloelectron voltage virtual monoenergetic images, iodine maps, and iodine overlay images can increase the conspicuity of contrast material extravasation and improve the visibility of subtle causes of GI bleeding, thereby increasing diagnostic confidence and assisting with problem solving. GI bleeding can also be diagnosed with routine single-phase DECT scans by constructing VNC images and iodine maps. Radiologists should also be aware of the potential pitfalls and limitations of DECT. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Bari Dane
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Avneesh Gupta
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Michael L Wells
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Mark A Anderson
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Jeff L Fidler
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Haresh V Naringrekar
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Brian C Allen
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Olga R Brook
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - David H Bruining
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Michael S Gee
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - David J Grand
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - David Kastenberg
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Ashish Khandelwal
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Neil Sengupta
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Jorge A Soto
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Flavius F Guglielmo
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
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Importance of communication of CT indication for imaging yield in patients with gastrointestinal bleed. Am J Emerg Med 2023; 64:101-105. [PMID: 36508753 DOI: 10.1016/j.ajem.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/26/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The indications for requesting a diagnostic test are important for the selection and timing of imaging protocols. We sought to evaluate the diagnostic yield and impact on patient disposition when evaluating computed tomography (CT) of the abdomen and pelvis in adult patients presenting with gastrointestinal bleeding (GIB) to the Emergency Department (ED). METHODS This study was an observational cohort study of consecutive adult ED patients with ICD10 codes related to GIB between 5/5/2018 and 6/1/2020. CT reports were reviewed for indications, exam type and findings. Reports were classified as positive (active bleeding, recent bleeding or suspected etiology for GIB), negative or other significant findings. Methodological guidelines for reporting observational studies were followed (STROBE). RESULTS Among 943 patients with GIB during the study period, 33% (n = 312) had an abdominopelvic CT ordered. Most CTs included contrast, 64.1% (n = 200) used a single portal venous phase and 28.9% (n = 90) were multi-phase. CT identified active bleeding in 4.2% (n = 13/312) and intraluminal blood in 2.9% (n = 9/312) patients. Patients that had GIB indications on the CT order (n = 142) were more likely to receive a multiphase study compared to those without GIB indication (n = 94) (43.0% vs. 8.5%, difference 34.5%, 95% CI 23.7% to 43.7%, p < 0.0001). Patients that received multiphase studies were more likely to have a source of GIB identified compared to single-phase (18.9% vs 1.5%, OR 15.3, 95% CI 4.4 to 53.7, p < 0.0001). In 40.3% (n = 117/290) of patients without bleeding, an intra-abdominal cause for their symptoms was identified. Those with GIB or with an identified cause were more likely to be admitted. CONCLUSIONS One-third of patients evaluated in the ED with GIB had a CT ordered. Active GIB was detected more often when multiphase exams were performed. Multiphase exams are done more often if GIB is listed in the CT indication. When a CT is positive, patients are more likely to be admitted or observed. Accurate indications are critical to optimize exam performance.
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Wang MX, Guccione J, Korivi BR, Abdelsalam ME, Klimkowski SP, Soliman M, Shalaby AS, Elsayes KM. Gastrointestinal bleeding: imaging and interventions in cancer patients. Br J Radiol 2022; 95:20211158. [PMID: 35451853 PMCID: PMC10996309 DOI: 10.1259/bjr.20211158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/03/2022] [Accepted: 04/05/2022] [Indexed: 11/05/2022] Open
Abstract
Gastrointestinal bleeding (GIB) among cancer patients is a major source of morbidity and mortality. Although a wide variety of etiologies contribute to GIB, special considerations should be made for cancer-related factors such as the type of malignancy, location and extent of disease, hemostatic parameters, and treatment effects. Key imaging modalities used to evaluate GIB include computed tomography angiography (CTA), radionuclide imaging, and catheter-based angiography. Understanding the cancer and treatment history and recognizing the associated imaging manifestations are important for identifying the source and potential causes of GIB in cancer patients. This article will review the common clinical presentations, causes, imaging manifestations, and angiographic management of GIB in cancer patients.
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Affiliation(s)
- Mindy X Wang
- Department of Diagnostic Imaging, University of Texas MD
Anderson Cancer Center, Houston,
TX, United States
| | | | - Brinda Rao Korivi
- Department of Diagnostic Imaging, University of Texas MD
Anderson Cancer Center, Houston,
TX, United States
| | - Mohamed E Abdelsalam
- Department of Interventional Radiology, University of Texas MD
Anderson Cancer Center, Houston,
TX, United States
| | - Sergio P Klimkowski
- Department of Diagnostic Imaging, University of Texas MD
Anderson Cancer Center, Houston,
TX, United States
| | - Moataz Soliman
- Department of Diagnostic Radiology, Northwestern University
Evanston, IL,
USA
| | - Ahmed S Shalaby
- Department of Diagnostic Imaging, University of Texas MD
Anderson Cancer Center, Houston,
TX, United States
| | - Khaled M Elsayes
- Department of Diagnostic Imaging, University of Texas MD
Anderson Cancer Center, Houston,
TX, United States
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8
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Xu J, Wang S, Wang X, Wang Y, Xue H, Yan J, Xu M, Jin Z. Effects of contrast enhancement boost postprocessing technique in combination with different reconstruction algorithms on the image quality of abdominal CT angiography. Eur J Radiol 2022; 154:110388. [DOI: 10.1016/j.ejrad.2022.110388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/22/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022]
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9
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Colonoscopy Versus Catheter Angiography for Lower Gastrointestinal Bleeding After Localization on CT Angiography. J Am Coll Radiol 2022; 19:513-520. [DOI: 10.1016/j.jacr.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 11/19/2022]
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10
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Snelling S, Ghaffar R, Ward ST. CT angiograms for lower GI bleeding: the experience of a large UK teaching hospital. Ann R Coll Surg Engl 2022; 104:100-105. [PMID: 34730424 PMCID: PMC9773912 DOI: 10.1308/rcsann.2021.0127] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The clinical presentation of lower gastrointestinal bleeding (LGIB) is variable in severity, cause and potential investigations. The British Society of Gastroenterology recently published LGIB guidelines, recommending CT angiography (CT-A) for haemodynamically unstable patients, defined by shock index (SI) greater than 1. The aim of this study was to assess the use and role of CT-A in diagnosing LGIB, by assessing the pickup rate of active LGIB defined by contrast extravasation or 'blush' and to determine any association between positive CT-A with various patient and clinical characteristics. METHODS A retrospective analysis was carried out of 4 years of LGIB admissions. Demographics, inpatient observations and use of blood products were acquired. Vital signs nearest the time of CT-A plus abnormal vital signs preceding imaging were used to calculate SI, Age SI, National Early Warning Score 2 (NEWS2) and Standardised Early Warning Score (SEWS). A consultant gastrointestinal radiologist further reviewed all consultant-reported scans. RESULTS In total, 930 patients were admitted with LGIB. Median age was 71 years and 51% were male; 179 (19.2%) patients received red blood cell transfusion and 93 patients (10%) underwent CT-A, who were older and were likely to be hypotensive and receive red cell transfusions. Following exclusions, 92 CT-As were included in the analysis. Nine (9.8%) were positive. Univariate analysis showed no association between positive CT-A and any scoring system. A multivariate analysis, including age and gender, showed association between both NEWS2 and SEWS scores with positive CT-A. CONCLUSION In our analysis of the typical LGIB population, CT-A has shown relatively low pick up rate of active bleeding. CT-A clearly has a role in the investigation of LGIB, but selection remains challenging.
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Affiliation(s)
- S Snelling
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - R Ghaffar
- University Hospitals Birmingham NHS Foundation Trust, UK
| | - ST Ward
- University Hospitals Birmingham NHS Foundation Trust, UK
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11
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Fidler JL, Guglielmo FF, Brook OR, Strate LL, Bruining DH, Gupta A, Allen BC, Anderson MA, Wells ML, Ramalingam V, Gunn ML, Grand DJ, Gee MS, Huete A, Khandalwal A, Sokhandon F, Park SH, Yoo DC, Soto JA. Management of gastrointestinal bleeding: Society of Abdominal Radiology (SAR) Institutional Survey. Abdom Radiol (NY) 2022; 47:2-12. [PMID: 34554300 DOI: 10.1007/s00261-021-03232-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 11/28/2022]
Abstract
Despite guidelines developed to standardize the diagnosis and management of gastrointestinal (GI) bleeding, significant variability remains in recommendations and practice. The purpose of this survey was to obtain information on practice patterns for the evaluation of overt lower GI bleeding (LGIB) and suspected small bowel bleeding. A 34-question electronic survey was sent to all Society of Abdominal Radiology (SAR) members. Responses were received from 52 unique institutions (40 from the United States). Only 26 (50%) utilize LGIB management guidelines. 32 (62%) use CT angiography (CTA) for initial evaluation in unstable patients. In stable patients with suspected LGIB, CTA is the preferred initial exam at 21 (40%) versus colonoscopy at 24 (46%) institutions. CTA use increases after hours for both unstable (n = 32 vs. 35, 62% vs. 67%) and stable patients (n = 21 vs. 27, 40% vs 52%). CTA is required before conventional angiography for stable (n = 36, 69%) and unstable (n = 15, 29%) patients. 38 (73%) institutions obtain two post-contrast phases for CTA. 49 (94%) institutions perform CT enterography (CTE) for occult small bowel bleeding with capsule endoscopy (n = 26, 50%) and CTE (n = 21, 40%) being the initial test performed. 35 (67%) institutions perform multiphase CTE for occult small bowel bleeding. In summary, stable and unstable patients with overt lower GI are frequently imaged with CTA, while CTE is frequently performed for suspected occult small bowel bleeding.
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Affiliation(s)
- Jeff L Fidler
- Department of Radiology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55902, USA.
| | - Flavius F Guglielmo
- Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Olga R Brook
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA
| | - Lisa L Strate
- Department of Gastroenterology, University of Washington, 325 9th Ave, Box 359728, Seattle, WA, 98105, USA
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55902, USA
| | - Avneesh Gupta
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, 3rd Floor FGH Building, Boston, MA, 02118, USA
| | - Brian C Allen
- Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC, 27710, USA
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Michael L Wells
- Department of Radiology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55902, USA
| | - Vijay Ramalingam
- Department of Radiology, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Boston, MA, 02215, USA
| | - Martin L Gunn
- Department of Radiology, University of Washington, 325 9th Ave, Box 359728, Seattle, WA, USA
| | - David J Grand
- Department of Radiology, Warren Alpert School of Medicine, Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Alvaro Huete
- Department of Radiology, Pontifical Catholic University, Marcoleta 367, Santiago, Chile
| | - Ashish Khandalwal
- Department of Radiology, Mayo Clinic, 200 First St., SW, Rochester, MN, 55902, USA
| | - Farnoosh Sokhandon
- Department of Radiology, Beaumont Health, IC 115, 3601 West Thirteen Mile Rd., Royal Oak, MI, 48073, USA
| | - Seong Ho Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Don C Yoo
- Department of Radiology, Warren Alpert School of Medicine, Brown University, 593 Eddy St, Providence, RI, 02903, USA
| | - Jorge A Soto
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, 3rd Floor FGH Building, Boston, MA, 02118, USA
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Guglielmo FF, Wells ML, Bruining DH, Strate LL, Huete Á, Gupta A, Soto JA, Allen BC, Anderson MA, Brook OR, Gee MS, Grand DJ, Gunn ML, Khandelwal A, Park SH, Ramalingam V, Sokhandon F, Yoo DC, Fidler JL. Gastrointestinal Bleeding at CT Angiography and CT Enterography: Imaging Atlas and Glossary of Terms. Radiographics 2021; 41:1632-1656. [PMID: 34597220 DOI: 10.1148/rg.2021210043] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gastrointestinal (GI) bleeding is a common potentially life-threatening medical condition frequently requiring multidisciplinary collaboration to reach the proper diagnosis and guide management. GI bleeding can be overt (eg, visible hemorrhage such as hematemesis, hematochezia, or melena) or occult (eg, positive fecal occult blood test or iron deficiency anemia). Upper GI bleeding, which originates proximal to the ligament of Treitz, is more common than lower GI bleeding, which arises distal to the ligament of Treitz. Small bowel bleeding accounts for 5-10% of GI bleeding cases commonly manifesting as obscure GI bleeding, where the source remains unknown after complete GI tract endoscopic and imaging evaluation. CT can aid in identifying the location and cause of bleeding and is an important complementary tool to endoscopy, nuclear medicine, and angiography in evaluating patients with GI bleeding. For radiologists, interpreting CT scans in patients with GI bleeding can be challenging owing to the large number of images and the diverse potential causes of bleeding. The purpose of this pictorial review by the Society of Abdominal Radiology GI Bleeding Disease-Focused Panel is to provide a practical resource for radiologists interpreting GI bleeding CT studies that reviews the proper GI bleeding terminology, the most common causes of GI bleeding, key patient history and risk factors, the optimal CT imaging technique, and guidelines for case interpretation and illustrates many common causes of GI bleeding. A CT reporting template is included to help generate radiology reports that can add value to patient care. An invited commentary by Al Hawary is available online. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Flavius F Guglielmo
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Michael L Wells
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - David H Bruining
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Lisa L Strate
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Álvaro Huete
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Avneesh Gupta
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Jorge A Soto
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Brian C Allen
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Mark A Anderson
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Olga R Brook
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Michael S Gee
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - David J Grand
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Martin L Gunn
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Ashish Khandelwal
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Seong Ho Park
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Vijay Ramalingam
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Farnoosh Sokhandon
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Don C Yoo
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
| | - Jeff L Fidler
- From the Department of Radiology, Thomas Jefferson University, 132 S 10th St, Philadelphia, Pa 19107 (F.F.G.); Department of Radiology (M.L.W., A.K., J.L.F.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Division of Gastroenterology, University of Washington School of Medicine, Seattle, Wash (L.L.S.); Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile (A.H.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B., V.R.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G., D.C.Y.); Department of Radiology, University of Washington, Seattle, Wash (M.L.G.); Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea (S.H.P.); and Department of Radiology, Beaumont Health, Oakland University William Beaumont School of Medicine, Royal Oak, Mich (F.S.)
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Mohammadinejad P, Kwapisz L, Fidler JL, Sheedy SP, Heiken JP, Khandelwal A, Wells ML, Froemming AT, Hansel SL, Lee YS, Inoue A, Halaweish AF, McCollough CH, Bruining DH, Fletcher JG. The utility of a dual-phase, dual-energy CT protocol in patients presenting with overt gastrointestinal bleeding. Acta Radiol Open 2021; 10:20584601211030658. [PMID: 34377539 PMCID: PMC8323435 DOI: 10.1177/20584601211030658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background Due to their easy accessibility, CT scans have been increasingly used for
investigation of gastrointestinal (GI) bleeding. Purpose To estimate the performance of a dual-phase, dual-energy (DE) GI bleed CT
protocol in patients with overt GI bleeding in clinical practice and examine
the added value of portal phase and DE images. Materials and Methods Consecutive patients with GI bleeding underwent a two-phase DE GI bleed CT
protocol. Two gastroenterologists established the reference standard.
Performance was estimated using clinical CT reports. Three GI radiologists
rated confidence in GI bleeding in a subset of 62 examinations, evaluating
first mixed kV arterial images, then after examining additional portal
venous phase images, and finally after additional DE images (virtual
non-contrast and virtual monoenergetic 50 keV images). Results 52 of 176 patients (29.5%) had GI bleeding by the reference standard. The
overall sensitivity, specificity, and positive and negative predictive
values of the CT GI bleed protocol for detecting GI bleeding were 65.4%,
89.5%, 72.3%, and 86.0%, respectively. In patients with GI bleeding,
diagnostic confidence of readers increased after adding portal phase images
to arterial phase images (p = 0.002), without additional
benefit from dual energy images. In patients without GI bleeding, confidence
in luminal extravasation appropriately decreased after adding portal phase,
and subsequently DE images (p = 0.006, p =
0.018). Conclusion A two-phase DE GI bleed CT protocol had high specificity and negative
predictive value in clinical practice. Portal venous phase images improved
diagnostic confidence in comparison to arterial phase images alone.
Dual-energy images further improved radiologist confidence in the absence of
bleeding.
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Affiliation(s)
| | - Lukasz Kwapisz
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Jeff L Fidler
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
| | - Shannon P Sheedy
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
| | - Jay P Heiken
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
| | | | - Michael L Wells
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
| | - Adam T Froemming
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
| | - Stephanie L Hansel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Yong S Lee
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
| | - Akitoshi Inoue
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
| | | | | | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA
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May Computed Tomography Scan as First-Line Investigation Reduce the Overuse of Colonoscopy in Post-Polypectomy Bleeding? Clin Gastroenterol Hepatol 2021; 19:851-852. [PMID: 33249023 DOI: 10.1016/j.cgh.2020.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/09/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023]
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Abstract
Dual-energy CT (DECT) overcomes several limitations of conventional single-energy CT (SECT) for the evaluation of gastrointestinal diseases. This article provides an overview of practical aspects of the DECT technology and acquisition protocols, reviews existing clinical applications, discusses current challenges, and describes future directions, with a focus on gastrointestinal imaging. A head-to-head comparison of technical specifications among DECT scanner implementations is provided. Energy- and material-specific DECT image reconstructions enable retrospective (i.e., after examination acquisition) image quality adjustments that are not possible using SECT. Such adjustments may, for example, correct insufficient contrast bolus or metal artifacts, thereby potentially avoiding patient recalls. A combination of low-energy monochromatic images, iodine maps, and virtual unenhanced images can be included in protocols to improve lesion detection and disease characterization. Relevant literature is reviewed regarding use of DECT for evaluation of the liver, gallbladder, pancreas, and bowel. Challenges involving cost, workflow, body habitus, and variability in DECT measurements are considered. Artificial intelligence and machine-learning image reconstruction algorithms, PACS integration, photon-counting hardware, and novel contrast agents are expected to expand the multienergy capability of DECT and further augment its value.
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Patel TV, Canario DAH, Isaacson AJ, Mauro DM. Vascular Etiologies of the Acute Abdomen. Semin Roentgenol 2020; 55:417-426. [PMID: 33220787 DOI: 10.1053/j.ro.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Tirth V Patel
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | | | - Ari J Isaacson
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - David M Mauro
- Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC.
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Loffroy R, Falvo N, Midulla M, Chevallier O. Arterial embolization for endoscopically unmanageable gastrointestinal bleeding remains the first-line therapy whatever the angiographic features. Scand J Gastroenterol 2020; 55:1308. [PMID: 32937085 DOI: 10.1080/00365521.2020.1821763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Romaric Loffroy
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Nicolas Falvo
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Marco Midulla
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
| | - Olivier Chevallier
- Department of Vascular and Interventional Radiology, Image-Guided Therapy Center, ImViA Laboratory-EA 7535, François-Mitterrand University Hospital, Dijon, France
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18
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Applications of Pediatric Body CT Angiography: What Radiologists Need to Know. AJR Am J Roentgenol 2020; 214:1019-1030. [DOI: 10.2214/ajr.19.22274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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SAR GI Bleeding DFP Annual Report. Abdom Radiol (NY) 2019; 44:3998-3999. [PMID: 31598764 DOI: 10.1007/s00261-019-02262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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