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Correlation of CT Angiography and 99m Technetium-Labeled Red Blood Cell Scintigraphy to Catheter Angiography for Lower Gastrointestinal Bleeding: A Single-Institution Experience.
- Source :
-
Journal of vascular and interventional radiology : JVIR [J Vasc Interv Radiol] 2019 Nov; Vol. 30 (11), pp. 1725-1732.e7. Date of Electronic Publication: 2019 Jul 03. - Publication Year :
- 2019
-
Abstract
- Purpose: To investigate the correlation of computed tomography (CT) angiography and <superscript>99m</superscript> Technetium-labeled red blood cell (RBC) scintigraphy to catheter angiography (CA) in the management of lower gastrointestinal bleeding (LGIB) while considering potential nephrotoxic effects of iodinated contrast.<br />Materials and Methods: From November 2012 to August 2017, 223 CAs performed for LGIB, including massive, ongoing, and obscure bleeding, were retrospectively identified in patients with pre-procedural CT angiography or RBC scintigraphy. Positive correlations and sensitivities were calculated for CT angiography and RBC scintigraphy using CA results as reference. Correlations were then compared while considering certain clinical presentations of LGIB. Contrast dose was compared with maximum creatinine recorded 48-72 hours after.<br />Results: Thirty-eight patients underwent CT angiography; 173 patients underwent RBC scintigraphy; and 12 patients completed both studies. CT angiography had a positive correlation of 67.7% (95% confidence interval [CI]: 57.0, 76.7) and sensitivity of 85.2% (95% CI: 66.3, 95.8), whereas RBC scintigraphy had a positive correlation of 29.3% (95% CI: 27.7, 31.0) and sensitivity of 94.4% (95% CI: 84.6, 98.8). CT angiography had higher positive correlation across all clinical presentations. No dose-toxicity relationship was observed between contrast and renal function (R <superscript>2</superscript> : 0.008), nor was there a difference in incidence of contrast-induced nephropathy between CT angiography and RBC scintigraphy (P = .30).<br />Conclusions: CT angiography has greater positive correlation to CA than RBC scintigraphy for assessing LGIB in active stable as well as hemodynamically unstable LGIB. As such, greater adoption of CT angiography may reduce the number of nontherapeutic CAs performed. Additional contrast associated with CT angiography does not result in increased nephrotoxicity.<br /> (Copyright © 2019 SIR. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adult
Aged
Aged, 80 and over
Contrast Media administration & dosage
Female
Gastrointestinal Hemorrhage etiology
Gastrointestinal Hemorrhage physiopathology
Hemodynamics
Humans
Male
Middle Aged
Predictive Value of Tests
Radiopharmaceuticals blood
Reproducibility of Results
Retrospective Studies
Risk Factors
Sodium Pertechnetate Tc 99m blood
Young Adult
Computed Tomography Angiography
Erythrocytes
Gastrointestinal Hemorrhage diagnostic imaging
Radionuclide Imaging methods
Radiopharmaceuticals administration & dosage
Sodium Pertechnetate Tc 99m administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1535-7732
- Volume :
- 30
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Journal of vascular and interventional radiology : JVIR
- Publication Type :
- Academic Journal
- Accession number :
- 31279683
- Full Text :
- https://doi.org/10.1016/j.jvir.2019.04.019