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Scintigraphic Screening Prior to Visceral Arteriography in Acute Lower Gastrointestinal Bleeding

Departments of Radiology and Medical Education, Indiana University, Indianapolis, Indiana
Department of Radiology, University of Chicago, Chicago, Illinois

Correspondence: For correspondence or reprints contact: Richard Gunderman, MD, PhD, Indiana University School of Medicine, Riley Hospital for Children, Rm. 1053, Department of Radiology, 702 North Barnhill Dr., Indianapolis, IN 46202.

ABSTRACT

We evaluated the effect on the diagnostic yield of visceral arteriography in patients with acute gastrointestinal bleeding of a protocol requiring a positive ^99mTc-red blood cell scintiscan before the performance of arteriography (scintigraphic screening). Methods: A retrospective review was conducted of 249 scintiscans and 271 arteriograms obtained over 99 mo, with scintigraphic screening implemented during the final 18 mo. Results: Before the implementation of scintigraphic screening, arteriograms detected bleeding at a rate of 22%. After its implementation, 53% of the arteriograms detected bleeding. This represented a statistically significant in crease (0.53 versus 0.22, p = 0.015). Conclusion: Scintigraphic screening appears to increase by a factor of 2.4 the diagnostic yield of arteriography by screening out patients who are not actively bleeding at the time of the examination, thus sparing them the risks and costs of a nondiagnostic invasive study.

Key Words: scintigraphic screening • gastrointestinal bleeding • technetium-99m-red blood cell scintigraphy • arteriography

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