Detection and localization of active gastrointestinal bleeding with multidetector row computed tomography...

To prospectively assess the utility of multidetector row computed tomography angiography (MDCTA) in the diagnosis of active gastrointestinal bleeding (GIB).

MDCTA is a relatively recent advance in CT scanning technology enabling excellent vascular visualization and detection of various vascular abnormalities. However, there is no prospective study with a large population evaluating the role of MDCTA in the diagnosis of active GIB.

From January 2006 to January 2011, 113 consecutive patients with clinical signs of active GIB underwent MDCTA (16-slice, 64-slice, or dual-source). The criteria for positive CT findings included active extravasation of contrast material within bowel lumen, abnormal bowel mucosal enhancement, vascular malformation, abnormally enhancing polyp or diverticulum, or tumor. Two radiologists reviewed the images and assessed CT findings in consensus. The standards of reference included digital subtraction angiography, endoscopy, surgery, or final pathology reports. Sensitivity, specificity, positive and negative predictive values, and accuracy of MDCTA for detection of active GIB were evaluated.

Positive CT findings for active GIB were identified in 80 of 113 patients (70.8%), all of which were confirmed by 1 or more reference standard. Negative MDCTA results were obtained in 33 patients (29.2%). Of these, 27 patients did not require any further intervention and were discharged without incident. The overall sensitivity, specificity, positive and negative predictive values, and accuracy of MDCTA was 86.0%, 100%, 100%, 60.6%, and 88.5%, respectively.

MDCTA is an accurate first-line screening method for detection and localization of GIB and can guide triage in patients with active GIB.