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Multi-section CT angiography compared with digital subtraction angiography in diagnosing major arterial hemorrhage in
Harpreet Hyare1, Sharmini Desigan, Helen Nicholl
1Department of Imaging, University College London Hospitals NHS Foundation Trust, University College Hospital, 235 Euston Road, London NW1 2BU, UK. hhyare@doctors.org.uk
Insights
Multi-section CT angiography accurately detects arterial bleeding in pancreatitis patients. This minimally invasive imaging technique offers high sensitivity and specificity, making it a valuable first-line diagnostic tool.
Area of Science:
- Radiology
- Gastroenterology
- Vascular Imaging
Background:
- Major arterial hemorrhage is a rare but severe complication of pancreatitis.
- Digital subtraction angiography (DSA) is the traditional gold standard but carries risks.
- Multi-section CT angiography offers a less invasive alternative with high-resolution imaging.
Purpose of the Study:
- To evaluate the accuracy of multi-section CT angiography for diagnosing arterial complications in inflammatory pancreatic disease.
- To compare the efficacy of CT angiography with DSA in detecting bleeding.
Main Methods:
- Retrospective analysis of 25 patients with pancreatitis-related bleeding between 1998 and 2004.
- Compared multi-section CT angiography findings with digital subtraction angiography (DSA) results.
- CT angiography was performed within 24 hours prior to DSA.
Main Results:
- CT angiography correctly identified bleeding in 18 of 19 positive DSA studies (sensitivity 0.947).
- It demonstrated high specificity (0.900) in detecting major arterial bleeding.
- One case of extravasation was detected by CT angiography but not DSA.
Conclusions:
- Multi-section CT angiography is a sensitive and accurate method for diagnosing arterial hemorrhage in pancreatitis.
- It should be considered the initial imaging modality for these patients.
- This technique offers a lower risk profile compared to DSA.
Purpose:
Major arterial hemorrhage is an uncommon but serious complication of pancreatitis with high morbidity and mortality. Digital subtraction angiography (DSA) has long been the gold standard for the detection of a visceral artery pseudoaneurysm or for the site of active bleeding in patients with pancreatitis. Multi-section CT angiography is a minimally invasive technique which can provide high-resolution and high-contrast images of the arterial lumen and wall, with a much lower risk of complication and morbidity compared to DSA. The aim of this study was to determine the accuracy of multi-section CT angiography for the diagnosis of arterial complications of inflammatory pancreatitic disease.
Materials And Methods:
A retrospective analysis of all patients undergoing visceral angiography for major bleeding as a complication of pancreatitis between 1998 and 2004 was performed. Twenty-nine studies in 25 patients (20 males, 5 females) with a mean age of 50.9 years (range 11-67 years) were identified where multi-section CT angiography was performed in the 24 h preceding the digital subtraction angiogram.
Results:
Digital subtraction angiography detected a pseudoaneurysm or contrast extravasation in 19 studies and no bleeding was demonstrated in 9 studies. CT angiography correctly identified the site and type of bleeding in 18 of the 19 positive studies. CT angiography detected extravasation of contrast in one study that was not demonstrated on digital subtraction angiography. The sensitivity and specificity for multi-section CT angiography for the detection of major arterial bleeding on a background of pancreatitis were 0.947 and 0.900, respectively.
Conclusion:
Multi-section CT angiography is a sensitive and accurate technique for the detection of major arterial hemorrhage in inflammatory pancreatic disease and should be considered as the first investigation in the management of these patients.
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