Time to conventional angiography in gastrointestinal bleeding: CT angiography compared to tagged RBC scan
Michael J Hsu1, Diana C Dinh2, Nemil A Shah1
1Department of Radiology, Boston Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA.
Insights
CT angiography (CTA) is faster than tagged red blood cell (RBC) scans for diagnosing gastrointestinal (GI) bleeding, reducing time to angiography and potential intervention. This faster diagnosis is crucial for improving patient outcomes in emergent GI bleeding cases.
Area of Science:
- Radiology
- Gastroenterology
- Interventional Radiology
Background:
- Gastrointestinal (GI) bleeding is a significant cause of morbidity and mortality.
- Timely diagnosis and intervention are critical for effective management of GI bleeding.
- Conventional angiography with catheter-directed embolization is a key intervention for active GI bleeding.
Purpose of the Study:
- To compare the time efficiency of CT angiography (CTA) versus tagged red blood cell (RBC) scan in patients with GI bleeding.
- To evaluate the time from diagnostic study to subsequent conventional angiography and embolization.
Main Methods:
- Retrospective study of 35 patients with GI bleeding undergoing angiography.
- Patients were divided into two groups: 15 diagnosed with CTA and 20 with tagged RBC scan.
- Time intervals including study order to completion and completion to angiography were calculated and compared using a t-test.
Main Results:
- Mean time from study order to completion was significantly shorter for CTA (3h 4min) compared to tagged RBC scan (5h 1min).
- Total mean time from study order to angiography intervention was significantly shorter for CTA (6h 8min) versus tagged RBC scan (9h 29min).
- No significant difference was found in the time from diagnostic study completion to angiography between the groups.
Conclusions:
- CT angiography (CTA) offers a faster diagnostic pathway to conventional angiography for GI bleeding compared to tagged RBC scans.
- The prolonged duration of tagged RBC scans contributes to the overall delay in intervention.
- Faster diagnosis and intervention through CTA can potentially reduce morbidity and mortality associated with GI bleeding.
Purpose:
To compare CT angiography (CTA) and tagged red blood cell (RBC) scan as a function of time from these initial imaging studies to subsequent conventional angiography and catheter-directed embolization in patients with gastrointestinal (GI) bleeding.
Methods:
An IRB-approved retrospective study was conducted of 35 consecutive patients diagnosed with GI bleeding that received angiography for planned catheter-directed embolization. Of these patients, 20 were diagnosed with bleeding using a tagged RBC scan, whereas 15 were diagnosed using CTA. The lengths of time between diagnostic study order to study completion, diagnostic study completion to angiography, and total time from diagnostic study order to angiography were calculated. The results of both groups were compared using a t test with p value of < 0.05 considered statistically significant.
Results:
The mean time from diagnostic study order to study completion was 3 h and 4 min for the CTA group and 5 h and 1 min for the tagged RBC scan group (p value = 0.0001). There was no statistically significant difference between the time to angiography after completion of the preceding diagnostic study. The total mean time from diagnostic study order to intervention was 6 h and 8 min for the CTA group and 9 h and 29 min for the tagged RBC scan group, a statistically significant difference (p value = 0.028).
Conclusions:
In patients requiring conventional angiography for GI bleeding, CT angiography results in a faster time to angiography than tagged RBC scan, which appears to be due to the longer duration required to complete the tagged RBC scan. Decreasing time to angiography is vital, as GI bleeding can be fatal and earlier diagnosis and intervention has the potential to reduce morbidity and mortality, while also increasing sensitivity of angiography. These findings may assist ordering clinicians in deciding on the appropriate diagnostic study.
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