Detection of active gastrointestinal hemorrhage with CT angiography: a 4(1/2)-year retrospective review

Area of Science:

• Radiology
• Gastroenterology
• Vascular Imaging

Background:

• Acute gastrointestinal (GI) hemorrhage of unknown origin presents a diagnostic challenge.
• Timely and accurate localization of bleeding is crucial for effective patient management and intervention.

Purpose of the Study:

• To evaluate the diagnostic performance of computed tomography (CT) angiography in identifying and localizing active GI bleeding from an unidentified source.
• To assess the utility of CT angiography in guiding subsequent clinical decisions for patients with acute GI hemorrhage.

Main Methods:

• Retrospective analysis of 86 CT angiograms from 74 patients diagnosed with acute GI hemorrhage of unknown source.
• Review of electronic medical records for subsequent interventions and correlation with surgical, endoscopic, and pathological reports.
• Calculation of sensitivity, specificity, accuracy, and predictive values for CT angiography in detecting active GI hemorrhage.

Main Results:

• CT angiography detected active hemorrhage in 26% of cases (22/86), with 86% confirmation (19/22) via angiography, surgery, or autopsy.
• Negative CT angiography results (64/86) rarely required further intervention (59/64), with no instances of missed bleeding confirmed by subsequent angiography.
• The study reported high performance metrics: 79% sensitivity, 95% specificity, 91% accuracy, 86% positive predictive value, and 92% negative predictive value.

Conclusions:

• CT angiography is a valuable tool for assessing active GI bleeding, providing crucial information for treatment planning.
• Its use prior to catheter angiography is supported in patients with acute GI bleeding considered for intervention, aiding in the decision-making process.
• CT angiography helps determine the appropriateness of catheter angiography and can guide mesenteric catheterization when a bleeding source is localized.