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Yaxley KL, Mulhem A, Godfrey S, Oke JL. The Accuracy of Computed Tomography Angiography Compared With Technetium-99m Labelled Red Blood Cell Scintigraphy for the Diagnosis and Localization of Acute Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis. Curr Probl Diagn Radiol 2023; 52:546-559. [PMID: 37271638 DOI: 10.1067/j.cpradiol.2023.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/26/2023] [Accepted: 05/08/2023] [Indexed: 06/06/2023]
Abstract
Imaging tests are commonly used as an initial or early investigation for patients presenting with suspected acute gastrointestinal bleeding (AGIB). However, controversy remains regarding which of two frequently used modalities, computed tomography angiography (CTA) or technetium-99m labelled red blood cell scintigraphy (RBCS), is most accurate. This systematic review and meta-analysis was performed to compare the accuracy of CTA and RBCS for the detection and localization of AGIB. Five electronic databases were searched with additional manual searching of reference lists of relevant publications identified during the search. Two reviewers independently performed screening, data extraction and methodological assessments. Where appropriate, the bivariate model was used for meta-analysis of sensitivities and specificities for the detection of bleeding and Freeman-Tukey double-arcsine transformation used for meta-analysis of proportions of correctly localized bleeding sites. Forty-four unique primary studies were included: twenty-two investigating CTA, seventeen investigating RBCS and five investigating both modalities. Meta-analysis produced similar pooled sensitivities; 0.83 (95% CI 0.74-0.90) and 0.84 (0.68-0.92) for CTA and RBCS respectively. Pooled specificity for CTA was higher than RBCS; 0.90 (0.72-0.97) and 0.84 (0.71-0.91) respectively. However, differences were not statistically significant. CTA was superior to RBCS in correctly localizing bleeding; pooled proportions of 1.00 (0.98-1.00) and 0.90 (0.83-0.96) respectively (statistically significant difference, P < 0.001). There is no evidence that CTA and RBCS have different diagnostic performance with respect to the detection of AGIB. However, CTA is superior to RBCS in terms of correctly localising the bleeding site, supporting usage of CTA over RBCS as the first line imaging investigation.
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Affiliation(s)
- Kaspar L Yaxley
- University of Oxford, 1 Wellington Square, Oxford, OX1 2JA, UK; Department of Medical Imaging, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, 5042, Australia.
| | - Ali Mulhem
- University of Oxford, 1 Wellington Square, Oxford, OX1 2JA, UK
| | - Sean Godfrey
- University of Oxford, 1 Wellington Square, Oxford, OX1 2JA, UK
| | - Jason L Oke
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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Barat M, Marchese U, Shotar E, Chousterman B, Barret M, Dautry R, Coriat R, Kedra A, Fuks D, Soyer P, Dohan A. Contrast extravasation on computed tomography angiography in patients with hematochezia or melena: Predictive factors and associated outcomes. Diagn Interv Imaging 2021; 103:177-184. [PMID: 34657834 DOI: 10.1016/j.diii.2021.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to identify variables associated with extravasation on computed tomography angiography (CTA) in patients with hematochezia/melena and compare the outcome of patients with extravasation on CTA to those without extravasation. MATERIAL AND METHODS Ninety-four patients (51 men, 38 women; mean age, 69 ± 16 [SD] years) who underwent CTA within 30 days of hematochezia/melena were included. Variables associated with extravasation on CTA were searched using univariable and multivariable analyses. Outcomes of patients with visible extravasation on CTA were compared with those without visible extravasation. RESULTS One hundred and one CTA examinations were included. Extravasation was observed on 26/101 CTA examinations (26%). At multivariable analysis the need for vasopressor drugs (odds ratio [OR], 7.6; P = 0.040), high transfusion requirements (> 2 blood units) (OR, 7.1; P = 0.014), CTA performed on the day of a hemorrhagic event (OR, 46.2; P = 0.005) and repeat CTA (OR, 27.8; P = 0.011) were independently associated with extravasation on CTA. Extravasation on CTA was followed by a therapeutic procedure in 25/26 CTAs (96%; 26 patients) compared to 13/75 CTAs (17%; 68 patients) on which no extravasation was present (P < 0.001). No patients (0/26; 0%) with contrast extravasation on CTA died while 8 patients (8/61; 13%) without contrast extravasation died, although the difference was not significant (P = 0.099). CONCLUSION Extravasation on CTA in the setting of hematochezia or melena is especially seen in clinically unstable patients who receive more than two blood units. Presence of active extravasation on CTA leads to more frequent application of a therapeutic procedure; however, this does not significantly affect patient outcome.
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Affiliation(s)
- Maxime Barat
- Department of Radiology A, Hôpital Cochin, APHP, Paris 75014, France; Faculté de Médecine, Université de Paris, Paris 75006, France.
| | - Ugo Marchese
- Faculté de Médecine, Université de Paris, Paris 75006, France; Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris 75014, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, AP-HP, Boulevard de l'Hôpital, Paris 75014, France
| | - Benjamin Chousterman
- Faculté de Médecine, Université de Paris, Paris 75006, France; Intensive Care unit, Hôpital Lariboisière, AP-HP, Paris 75010, France
| | - Maximilien Barret
- Faculté de Médecine, Université de Paris, Paris 75006, France; Department of Gastroenterology, Hôpital Cochin, APHP, Paris 75014, France
| | - Raphael Dautry
- Department of Radiology A, Hôpital Cochin, APHP, Paris 75014, France
| | - Romain Coriat
- Faculté de Médecine, Université de Paris, Paris 75006, France; Department of Gastroenterology, Hôpital Cochin, APHP, Paris 75014, France
| | - Alice Kedra
- Department of Radiology A, Hôpital Cochin, APHP, Paris 75014, France
| | - David Fuks
- Faculté de Médecine, Université de Paris, Paris 75006, France; Department of Digestive, Hepato-biliary and Endocrine Surgery, Referral Center for Rare Adrenal Diseases, Cochin Hospital, APHP, Paris 75014, France
| | - Philippe Soyer
- Department of Radiology A, Hôpital Cochin, APHP, Paris 75014, France; Faculté de Médecine, Université de Paris, Paris 75006, France
| | - Anthony Dohan
- Department of Radiology A, Hôpital Cochin, APHP, Paris 75014, France; Faculté de Médecine, Université de Paris, Paris 75006, France
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Transcatheter Arterial Embolization of Spontaneous Soft Tissue Hematomas: A Systematic Review. Cardiovasc Intervent Radiol 2018; 42:335-343. [DOI: 10.1007/s00270-018-2086-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/28/2018] [Indexed: 12/12/2022]
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Lee NJ, Shin JH, Lee SS, Park DH, Lee SK, Yoon HK. Transcatheter arterial embolization for iatrogenic bleeding after endoscopic ultrasound-guided pancreaticobiliary drainage. Diagn Interv Imaging 2018; 99:717-724. [PMID: 30033142 DOI: 10.1016/j.diii.2018.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/26/2018] [Accepted: 06/28/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The purpose of this study was to report the incidence of massive bleeding after endoscopic ultrasound-guided transmural pancreaticobiliary drainage (EUS-TPBD) and the clinical outcomes in patients with this condition treated with transcatheter arterial embolization (TAE). PATIENTS AND METHODS We performed a 9-year retrospective analysis of 797 EUS-TPBD procedures (excluding gallbladder or pseudocysts) in 729 patients. Among them, twelve (12/729, 1.65%) patients were referred for TAE to manage active bleeding adjacent to the TPBD sites. There were 8 men and 4 women with a mean age of 66.1 years±13.4 (SD) (range: 45-89 years). The clinical and procedure data of these 12 patients were reviewed. RESULTS Thirteen TAE procedures in 12 patients were performed. The bleeding sites were the left hepatic artery (n=7), the right hepatic artery (n=3), the left gastric artery (n=1), the left accessory gastric artery (n=1) and gastroduodenal artery (n=1). TAE was performed with gelatin sponge particles (n=1), coil (n=1) and n-butyl-2 cyanoacrylate with/without coils (n=11), with technical and clinical success rates of 100% (13/13) and 85% (11/13), respectively. Re-bleeding following embolization with gelatin sponge particles occurred in one patient. Procedure-related ischemic hepatitis was observed in another patient with pancreatic cancer with portal vein involvement. CONCLUSION On the basis of our results, TAE using n-butyl-2 cyanoacrylate seems safe and effective for the treatment of bleeding after EUS-TPBD procedures. When the portal vein is compromised, TAE of the hepatic artery can cause ischemic liver damage.
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Affiliation(s)
- N J Lee
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - J H Shin
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
| | - S S Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - D H Park
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - S K Lee
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - H-K Yoon
- Department of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Shotar E, Soyer P, Barat M, Dautry R, Pocard M, Placé V, Camus M, Eveno C, Barret M, Dohan A. Diagnosis of acute overt gastrointestinal bleeding with CT-angiography: Comparison of the diagnostic performance of individual acquisition phases. Diagn Interv Imaging 2017; 98:857-863. [PMID: 28754326 DOI: 10.1016/j.diii.2017.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare the respective values of arterial phase, portal venous phase and combination of phases using 64-section multidetector computed tomography (MDCT) for diagnosing acute overt gastrointestinal bleeding (AOGIB). PATIENTS AND METHODS Forty-nine patients with AOGIB were included. There were 30 men and 19 women, with a mean age of 65.4±15.6 (SD) years [range, 34-91years]. Two observers reviewed MDCT examinations in consensus for presence of active bleeding, location of bleeding site and nature of causative lesion. The different acquisition phases were reviewed independently. RESULTS AOGIB was identified in 28/49 patients (57%) with the multiphasic set, in 26/49 patients (53%) with arterial phase and in 25/49 patients (51%) with portal venous phase. Multiphasic set helped locate the bleeding site in 40/49 patients (82%). The cause was elucidated in 23/49 patients (47%) with multiphasic set. The differences between set performances were not statistically significant. Sensitivity for depicting AOGIB with the multiphasic set was 92% and specificity was 76%. CONCLUSION Multiphasic 64-section MDCT has high diagnostic performances in patients with AOGIB. Further studies with a larger population are needed to reach statistical significance and demonstrate better diagnostic performance of multiphasic MDCT in comparison with the arterial or portal phase alone.
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Affiliation(s)
- E Shotar
- Department of Body and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - P Soyer
- Université Paris 5, Sorbonne Paris Cité, rue de l'école de médecine, 75006 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Amboise-Paré, 75010 Paris, France; Department of Radiologie, hôpital Cochin, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - M Barat
- Department of Body and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - R Dautry
- Department of Body and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - M Pocard
- Université Paris 5, Sorbonne Paris Cité, rue de l'école de médecine, 75006 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Amboise-Paré, 75010 Paris, France; Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - V Placé
- Department of Body and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - M Camus
- Department of Gastroenterology, hôpital Saint-Antoine, AP-HP, 184, rue du Faubourg Saint-Antoine, 75012 Paris, France
| | - C Eveno
- Université Paris 5, Sorbonne Paris Cité, rue de l'école de médecine, 75006 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Amboise-Paré, 75010 Paris, France; Department of Surgical Oncology, hôpital Lariboisière, AP-HP, 2, rue Ambroise Paré, 75475 Paris cedex 10, France
| | - M Barret
- Department of Gastroenterology, hôpital Cochin, AP-HP, 27, rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - A Dohan
- Department of Body and Interventional Imaging, hôpital Lariboisière, AP-HP, 2, rue Ambroise Paré, 75475 Paris cedex 10, France; Université Paris 5, Sorbonne Paris Cité, rue de l'école de médecine, 75006 Paris, France; UMR Inserm 965, hôpital Lariboisière, 2, rue Amboise-Paré, 75010 Paris, France.
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