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Acute Lower Gastrointestinal Bleeding: Temporal Factors Associated With Positive Findings on Catheter Angiography

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Time to positive (TTP) of 9 minutes or less significantly increases the detection of acute lower gastrointestinal bleeding (LGIB) via catheter angiography (CA). Delayed CA after radionuclide blush appearance reduces positive findings.

Keywords:
RBC scanangiographygastrointestinal bleeding gastrointestinal hemorrhagetechnetiumtechnetium-99m sulfur colloid

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Area of Science:

  • Radiology
  • Nuclear Medicine
  • Gastroenterology

Background:

  • Acute lower gastrointestinal bleeding (LGIB) diagnosis often involves radionuclide imaging and catheter angiography (CA).
  • Optimizing the timing between these diagnostic modalities is crucial for improving diagnostic yield.

Purpose of the Study:

  • To investigate the impact of time to positive (TTP) and lag time (LT) on the diagnostic yield of CA for acute LGIB.

Main Methods:

  • Retrospective analysis of 120 patients with confirmed acute LGIB on Tc-99m labeled RBC scans who underwent CA.
  • Independent review of radionuclide scans and angiograms by fellowship-trained radiologists.
  • Statistical analysis using SAS software.

Main Results:

  • A TTP threshold of ≤ 9 minutes demonstrated high sensitivity (92%) and specificity (35%) for positive CA.
  • The odds of detecting bleeding on CA increased 6.1-fold with a TTP ≤ 9 minutes.
  • A significant inverse relationship was observed between LT and positive CA findings (p=0.041).

Conclusions:

  • TTP and LT significantly influence the success rate of CA in detecting acute LGIB.
  • A TTP ≤ 9 minutes identifies most patients who will benefit from CA, reducing unnecessary procedures.
  • Delayed CA after radionuclide blush appearance decreases the likelihood of positive findings.