The Role of Nuclear Medicine in the Detection of Acute Gastrointestinal Bleeding
Section snippets
99mTc-Labeled Autologous Erythrocyte Scintigraphy
Because of the ready availability of good quality commercial kits, enabling rapid and reliable erythrocyte labeling and the ability to image in dynamic early-phase followed by extended equilibrium-phase, this technique is currently the most popular method. Variations in the technique exist, including in vivo, modified in vitro, and in vitro imaging protocols (Table 1). These imaging protocols have previously been well described.11, 12, 13, 14 This test is commonly indicated when, in the
99mTc-Labeled Sulfur Colloid Scintigraphy
This technique was first described in animal experiments in 197721 A recommended imaging protocol is shown in Table 2. The principle of radiolabeled sulfur colloid imaging relates to the use of this radiotracer as an early phase vascular imaging agent that is rapidly cleared from the vascular space by extraction to liver, spleen and bone marrow. Consequently, extravasation from a vascular source, such as that which occurs during active gastrointestinal bleeding, will potentially yield a high
Other Techniques
99mTc-labeled albumin was the earliest intravascular agent used to detect gastrointestinal bleeding.20 This technique showed promising results but was soon surpassed by techniques using more reliable labeling techniques.2499mTc-labeled heat-damaged erythrocytes also have been used as an intravascular technique where a high target-to-background ratio is achieved by clearance of damaged erythrocytes by the spleen and extravasation of labeled-heat-damaged erythrocytes at a site of active
Meckel’s Diverticulum
Bleeding from a Meckel’s diverticulum can potentially occur at any age but is more likely to occur in infancy or early childhood. A Meckel’s diverticulum is an embryological remnant caused by incomplete closure of the omphalomesenteric duct, most commonly located in the distal ileum. It is not known what proportion of these diverticulae contain ectopic mucosa, but estimates range from 10% to 60%.29, 30, 31 The most common type of ectopic tissue in Meckel’s diverticulae is gastric mucosa, and
Image Interpretation Pitfalls
Interpretation of 99mTc sulfur colloid imaging in the upper abdomen may be problematic in certain clinical settings because of reticuloendothelial cell uptake of this radiotracer within liver and spleen. Also, potential false-positive interpretation of focal abnormal uptake has been reported as the result of an accessory spleen.48 Unexpected bleeding from a ruptured spleen also has been reported using 99mTc labeled erythrocyte scintigraphy,49 as well as a photopenic region seen in the spleen on
Patient Risk Stratification
A retrospective study of 565 hospitalizations (488 patients) for AGH in a large tertiary referral hospital during a 7-year period showed that in 89% of cases bleeding stopped spontaneously,87 which is an indicator as to the vagaries of AGH and the difficulties involved in establishing protocols for the management of patients. A large proportion of patients admitted to hospital with AGH will be discharged from hospital without a satisfactory diagnosis for the cause of bleeding.88 Consequently,
Recommended Roles of Imaging Modalities
The role of nuclear medicine scintigraphy in the detection of lower gastrointestinal hemorrhage fits into a neat theoretically algorithm. This algorithm places the scintigraphy study as one of the first imaging investigations to be performed with the aim of determining a sufficient rate of bleeding to facilitate successful angiography and possible angiographic intervention.16 However, gastrointestinal bleeding is a law unto itself with respect to timing, severity, and clinical context.
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Cited by (112)
Tc-99m scan for pediatric bleeding Meckel diverticulum:a systematic review and meta-analysis
2023, Jornal de PediatriaRadiolabeling of red blood cells and platelets and quality controls
2022, Nuclear Medicine and Molecular Imaging: Volume 1-4A Practical Guide to the Evaluation of Small Bowel Bleeding
2022, Mayo Clinic ProceedingsCitation Excerpt :The test can detect bleeding rates as low as 0.2 mL/min, leading to mildly increased sensitivity compared with CTA.1 However, localization of the bleed can be difficult and CTA is likely superior in this regard.25,26 Consequently, CTA is often considered first line in cases of presumed brisk small bowel bleeding.
On-cartridge preparation and evaluation of <sup>68</sup>Ga-, <sup>89</sup>Zr- and <sup>64</sup>Cu-precursors for cell radiolabelling
2019, Nuclear Medicine and BiologyImaging Workup of Acute and Occult Lower Gastrointestinal Bleeding
2018, Radiologic Clinics of North AmericaCitation Excerpt :When positive findings are seen, the examination can be discontinued once the clinician is confident of the origin of the bleed.15 Nuclear scintigraphy is the most sensitive test to image GI bleeding, as it can detect bleeding rates as low as 0.05 mL/min.16 Other advantages include that the test is noninvasive and that no patient preparation is needed other than obtaining a blood sample.
Radiologic Assessment of Gastrointestinal Bleeding
2018, Gastroenterology Clinics of North America