Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi-detector row helical CT

Area of Science:

• Radiology
• Gastroenterology
• Medical Imaging

Background:

• Acute massive gastrointestinal (GI) bleeding is a critical condition requiring rapid diagnosis.
• Conventional diagnostic methods may have limitations in identifying the precise bleeding source.
• Multi-detector row helical computed tomography (CT) offers advanced imaging capabilities for evaluating GI pathologies.

Purpose of the Study:

• To prospectively assess the accuracy of arterial phase multi-detector row helical CT in detecting and localizing acute massive GI bleeding.
• To compare the diagnostic performance of CT with angiography, used as the reference standard.

Main Methods:

• Twenty-six patients with acute massive GI bleeding underwent arterial phase multi-detector row CT prior to angiography.
• CT scans were analyzed for contrast material extravasation within the bowel lumen, indicative of active bleeding.
• Sensitivity, specificity, and accuracy for detection and localization were calculated and compared with angiographic findings.

Main Results:

• Arterial phase multi-detector row CT identified contrast extravasation in 21 out of 26 patients.
• Location-based sensitivity was 90.9% and specificity was 99%, with an overall accuracy of 97.6%.
• Patient-based accuracy for detecting acute GI bleeding was 88.5%, and localization precisely matched angiographic findings.

Conclusions:

• Arterial phase multi-detector row CT is a highly accurate imaging modality for both the detection and precise localization of bleeding sites in patients experiencing acute massive GI bleeding.
• The technique demonstrates significant diagnostic value, supporting its use in the management of these critical cases.