Gastrointestinal bleeding and cine-scintigraphy

doi:10.1016/S0001-2998(96)80015-8

Seminars in Nuclear Medicine

Volume 26, Issue 1, January 1996, Pages 43-50

https://doi.org/10.1016/S0001-2998(96)80015-8 Get rights and content

Two recent advances have significantly improved the ability of labeled red cell imaging to localize and to detect sites of active gastrointestinal bleeding. The first is the use of continuous dynamic imaging. The second is the commercial availability of an in vitro red cell labeling method that significantly improves image quality. The computer equipment required for dynamic imaging is available in most nuclear medicine laboratories. Because cinematic display of the dynamic images increases the accuracy and ease of interpretation it should be considered the method of choice for performing gastrointestinal bleeding studies. High-risk patients can be identified if very active bleeding is noted early. However, a study with negative results, after monitoring the patient over 1 to 2 hours, suggests that conservative medical management may be adequate. Therefore, with proper use scintigraphy can provide both diagnostic and prognostic information to aid in the management of patients with gastrointestinal bleeding.

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Cited by (24)

Gastrointestinal Hemorrhage
2007, Textbook of Gastrointestinal Radiology
The role of nuclear medicine in the detection of acute gastrointestinal bleeding
2006, Seminars in Nuclear Medicine
Citation Excerpt :
Consequently, the published literature contains a broad range of sensitivities and specificities in an attempt to convey comparative imaging value to scintigraphy imaging as well as other imaging modalities.24,96,106-113 Theoretically, 99mTc-labeled red cell scintigraphy can be used to detect intermittent lower gastrointestinal hemorrhage where other methods have a low probability of detecting active bleeding.11 In practice, however, more often than not, prolonged imaging using 99mTc-labeled red blood cell scintigraphy is negative.
The clinical consequences of lower gastrointestinal bleeding range from trivial to life-threatening. Nuclear medicine imaging techniques allow identification of those patients who are actively bleeding. The demonstration of active bleeding not only provides important prognostic information but also allows for a coordinated imaging approach using angiography and aids localization of the bleeding site. ^99mTc-labeled erythrocytes and ^99mTc sulfur colloid are 2 commonly used techniques to detect active bleeding. Each has its respective advantages and disadvantages, but the medical literature indicates that both tests are useful. More prolonged or delayed imaging is possible using ^99mTc-labeled erythrocytes but care is required to prevent misinterpretation of the bleeding location because of a higher likelihood of radiotracer movement through the bowel away from the bleeding site. These forms of scintigraphy may be helpful in risk-stratifying patients and planning radiological and surgical interventions. Careful selection of patients to include those who have a high likelihood of active bleeding greatly increases the clinical utility of these tests. In addition, ^99mTc pertechnetate imaging may be diagnostic of ectopic gastric mucosa in a Meckel’s diverticulum as a potential source of bleeding. Patients also should be carefully selected for this test, based on age and exclusion of other causes of bleeding.
Radiologic diagnosis and treatment of gastrointestinal hemorrhage and ischemia
2002, Medical Clinics of North America
Radiology in the diagnosis and therapy of gastrointestinal bleeding
2000, Gastroenterology Clinics of North America
Citation Excerpt :
Bleeding localization is only approximate because of movement of extravasated contrast material by bowel peristalsis. Cine images are used to detect and follow peristaltic movements.14,57,58,69 When a bleeding scan fails to show active bleeding, angiography presumably also would not show active bleeding and is usually not performed.
Despite the prominence of gastrointestinal (GI) endoscopy in the evaluation of GI bleeding, radiologic techniques and therapy are an important component of the armamentarium in evaluating and treating GI bleeding, particularly when the bleeding site is obscure or undetermined after thorough endoscopic evaluation, when the bleeding is massive or refractory to endoscopic therapy, or when the bleeding is associated with a mass or suspected cancer. GI bleeding, especially when severe or refractory, is best managed by a team approach with the team including the radiologist, internist, intensivist, gastroenterologist, and surgeon.
Although upper GI endoscopy is the initial procedure of choice to evaluate acute upper GI bleeding, upper GI endoscopy is nondiagnostic in about 10% of cases.⁵³ Patients with a nondiagnostic upper GI endoscopy study, in whom making a diagnosis is most important, are often at highest risk from bleeding. For example, upper GI endoscopy is often nondiagnostic in the massive bleeder because intraluminal gastric blood cannot be adequately cleared. Although colonoscopy is often the initial diagnostic procedure for acute lower GI bleeding, emergency colonoscopy may miss the diagnosis in 40% of cases.17, 39 Small bowel bleeding beyond the ligament of Treitz, although uncommon, is difficult to diagnose by endoscopy: Enteroscopy is available primarily at tertiary care centers, requires considerable endoscopic expertise, and has only a moderate sensitivity.
When diagnostic endoscopy is unsuccessful, bleeding scans and angiography often can localize the site and determine the cause of bleeding. A preoperative angiographic diagnosis greatly reduces the morbidity and mortality of surgery for GI bleeding.⁷⁴ Although endoscopic therapy is usually the initial intervention for GI lesions that are actively bleeding or at high risk of rebleeding, endoscopic therapy fails to achieve hemostasis in about 20% of cases.35, 44 When therapeutic endoscopy is unsuccessful, interventional radiology provides a nonoperative modality to control GI bleeding. Angiographic therapy can avoid the high morbidity and mortality of emergency GI surgery.
During the past 25 years, new diagnostic and therapeutic radiologic techniques have revolutionized the management of obscure or refractory GI bleeding. Radionuclide scanning, with technetium 99m (^99mTc) sulfur colloid or (^99mTc)-labeled erythrocytes, is frequently used to localize mild-to-moderate or intermittent bleeding, particularly in the lower GI tract, and ^99mTc pertechnetate is used to detect Meckel's diverticulum. Superselective angiographic catheterization and microcoil embolization are now frequently used to diagnose and treat acute upper and lower GI bleeding. Transjugular intrahepatic portosystemic shunt (TIPS) is now used to control variceal bleeding.
Gastrointestinal bleeding is generally categorized as upper (from the esophagus to the ligament of Treitz) or lower (from the ligament of Treitz to the anus) and as acute or chronic. This article reviews the role of bleeding scans and diagnostic and therapeutic angiography in managing acute upper and lower GI bleeding and in managing chronic GI bleeding. TIPS is discussed in detail in another article devoted to radiologic and surgical therapy for variceal bleeding.
Gallbladder visualization on Tc-99m-labeled red cell scintigraphy: A rare finding with an emphasis on role of single-photon emission computed tomography/computed tomography
2017, Indian Journal of Nuclear Medicine
Gastrointestinal bleeDing scintigraphy in the early 21st century
2016, Journal of Nuclear Medicine

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Gastrointestinal bleeding and cine-scintigraphy

Mayo Clin Proc

Gastrointest Endosc

Radiol Clin North Am

Surg Clin North Am

Semin Nuc Med

Semin Nuc Med

Upper gastrointestinal hemorrhage

Mayo Clin Proc

A study of the factors influencing mortality rates from gastrointestinal haemorrhage

Q J Med

Predictors of outcome in massive upper gastrointestinal hemorrhage

J Clin Gastroenterol

Upper gastrointestinal bleeding: Nature and magnitude of the problem in the U.S

Dig Dis Sci

Clinical approach to diagnostic endoscopy in patients with upper gastrointestinal bleeding

Dig Dis Sci

Colonoscopy in acute rectal bleeding

Gastrointest Endosc

Colonoscopy after golytely preparation in acute rectal bleeding

J Clin Gastroenterol

Angiography in the management of massive lower gastrointestinal tract hemorrhage

Surg Gynecol Obstet

Intermittent bleeding from minute to minute in acute massive gastrointestinal hemorrhage: Arteriographic demonstration

AJR

Scintigraphic detection of acute gastrointestinal bleeding

Radiology

Minimum gastrointestinal bleeding rate detectable by abdominal scintigraphy

J Nucl Med