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Related Experiment Video

Updated: Jul 8, 2026

Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging
09:32

Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging

Published on: December 9, 2021

CTA-positive, angiography-negative lower GI bleeding: an institutional imaging-guided management algorithm.

Elias Lugo-Fagundo1,2, Hajra Ashrad3, Carolina Lugo-Fagundo4,3

  • 1Office of Medical Education, Duke University School of Medicine, 8 Searle Center Dr. Durham, Durham, NC, 27710, USA. elias.lugofagundo@duke.edu.

Emergency Radiology
|July 7, 2026
PubMed
Summary

Diagnosing lower gastrointestinal bleeding (LGIB) can be challenging when computed tomography angiography (CTA) shows bleeding but transcatheter angiography (TA) does not. This study proposes an imaging-guided strategy to manage these complex LGIB cases.

Keywords:
AngiographyColonoscopyComputed tomography angiographyEmbolizationEmergency radiologyGastrointestinal bleeding

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Last Updated: Jul 8, 2026

Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging
09:32

Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging

Published on: December 9, 2021

Area of Science:

  • Medical Imaging
  • Gastroenterology
  • Emergency Medicine

Background:

  • Lower gastrointestinal bleeding (LGIB) is a common emergency department presentation.
  • Accurate diagnosis and timely intervention are critical for managing LGIB.
  • A discrepancy exists between computed tomography angiography (CTA) and transcatheter angiography (TA) findings in some LGIB cases.

Purpose of the Study:

  • To propose an institutional, imaging-guided management strategy for LGIB.
  • To address the diagnostic and therapeutic dilemma of CTA-positive but TA-negative LGIB.
  • To optimize patient care by guiding decisions on imaging selection, level of care, and interventions.

Main Methods:

  • Review of diagnostic modalities for LGIB, including colonoscopy, nuclear medicine, cross-sectional imaging, CTA, and TA.
  • Development of a tiered management strategy for CTA-positive/TA-negative LGIB.
  • Emphasis on a multimodal diagnostic approach tailored to patient's hemodynamic status and clinical trajectory.

Main Results:

  • CTA is emerging as a first-line tool for LGIB, especially in unstable patients.
  • Discordance between CTA and TA may stem from intermittent bleeding or differing detection thresholds.
  • The proposed strategy involves conservative management, provocative angiography, and selective colonoscopy.

Conclusions:

  • An imaging-guided, tiered approach can effectively manage CTA-positive/TA-negative LGIB.
  • Management should be individualized based on clinical factors and ongoing bleeding evidence.
  • This strategy aims to reduce diagnostic uncertainty and improve outcomes in acute LGIB.