Lower gastrointestinal bleeding other imaging findings: Difference between revisions

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==Other Imaging Findings==
==Other Imaging Findings==
===Radionuclide imaging===
===Radionuclide imaging===
*Radionuclide imaging is more sensitive than angiography in detecting the source of bleeding; however, it is less specific than either a positive endoscopic or angiographic examination.
*Radionuclide imaging is more sensitive than angiography in detecting the source of bleeding; however, it is less specific than either a positive endoscopic or angiographic examination.<ref name="pmid2541861">{{cite journal |vauthors=Nicholson ML, Neoptolemos JP, Sharp JF, Watkin EM, Fossard DP |title=Localization of lower gastrointestinal bleeding using in vivo technetium-99m-labelled red blood cell scintigraphy |journal=Br J Surg |volume=76 |issue=4 |pages=358–61 |year=1989 |pmid=2541861 |doi= |url=}}</ref><ref name="pmid6969790">{{cite journal |vauthors=Flickinger FW |title=Location of active lower GI bleeding by technetium-99m sulfur colloid scan |journal=J. Nucl. Med. |volume=22 |issue=1 |pages=38–9 |year=1981 |pmid=6969790 |doi= |url=}}</ref><ref name="pmid3873332">{{cite journal |vauthors=Hahn K, Kraus W, Eissner D |title=[Nuclear medical detection of hemorrhage in the gastrointestinal tract] |language=German |journal=Dtsch. Med. Wochenschr. |volume=110 |issue=23 |pages=923–4 |year=1985 |pmid=3873332 |doi=10.1055/s-2008-1068933 |url=}}</ref><ref name="pmid8568406">{{cite journal |vauthors=Rantis PC, Harford FJ, Wagner RH, Henkin RE |title=Technetium-labelled red blood cell scintigraphy: is it useful in acute lower gastrointestinal bleeding? |journal=Int J Colorectal Dis |volume=10 |issue=4 |pages=210–5 |year=1995 |pmid=8568406 |doi= |url=}}</ref>
*Rates of bleeding as little as 0.1 to 0.5 mL/min can be detected.
*Rates of bleeding as little as 0.1 to 0.5 mL/min can be detected.
*Radionuclide imaging is indicated prior to angiography in patients in whom the bleeding is intermittent or has a low rate, or in whom bleeding points were not identified using CTA, angiography, or colonoscopy.
*Radionuclide imaging is indicated prior to angiography in patients in whom the bleeding is intermittent or has a low rate, or in whom bleeding points were not identified using CTA, angiography, or colonoscopy.
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====Contraindications====
====Contraindications====
*Radionuclide imaging is not recommended in pregnant or breastfeeding women.
*Radionuclide imaging is not recommended in pregnant or breastfeeding women.
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Revision as of 20:26, 14 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Other imaging studies include radionuclide imaging that can be helpful in diagnosing lower gastrointestinal bleeding.

Other Imaging Findings

Radionuclide imaging

  • Radionuclide imaging is more sensitive than angiography in detecting the source of bleeding; however, it is less specific than either a positive endoscopic or angiographic examination.[1][2][3][4]
  • Rates of bleeding as little as 0.1 to 0.5 mL/min can be detected.
  • Radionuclide imaging is indicated prior to angiography in patients in whom the bleeding is intermittent or has a low rate, or in whom bleeding points were not identified using CTA, angiography, or colonoscopy.
  • Accuracy rates have varied across reports, and range from 24% to 91%.

Procedure

  • Erythrocytes are initially labeled by intravenously injecting 2 mL of a stannous agent.
  • Twenty minutes later, 400 MBq of technetium pertechnetate are injected.
  • Scans are then performed every 5 minutes for up to an hour.
  • Single static images are taken several hours later

Nuclear scanning agents

  • Two different types of nuclear scanning agents are commonly used: technetium (99mTc) sulphur colloid, which has a short half-life, and 99mTc pertechnetate, which has a longer half-life.
  • With 99mTc pertechnetate, patients can be scanned several times over a 24-hour period. Therefore the latter agent has become the favored radiotracer to use

Advantages

  • Advantages common to both techniques are that they are noninvasive and have a higher sensitivity than does angiography.

Disadvantages

  • The main disadvantages are that radionuclide scanning can only localize bleeding to an area of the abdomen, and the resolution does not allow the identification of a specific site in the colon.
  • Anaphylactic reaction to the radioisotope

Contraindications

  • Radionuclide imaging is not recommended in pregnant or breastfeeding women.

References

  1. Nicholson ML, Neoptolemos JP, Sharp JF, Watkin EM, Fossard DP (1989). "Localization of lower gastrointestinal bleeding using in vivo technetium-99m-labelled red blood cell scintigraphy". Br J Surg. 76 (4): 358–61. PMID 2541861.
  2. Flickinger FW (1981). "Location of active lower GI bleeding by technetium-99m sulfur colloid scan". J. Nucl. Med. 22 (1): 38–9. PMID 6969790.
  3. Hahn K, Kraus W, Eissner D (1985). "[Nuclear medical detection of hemorrhage in the gastrointestinal tract]". Dtsch. Med. Wochenschr. (in German). 110 (23): 923–4. doi:10.1055/s-2008-1068933. PMID 3873332.
  4. Rantis PC, Harford FJ, Wagner RH, Henkin RE (1995). "Technetium-labelled red blood cell scintigraphy: is it useful in acute lower gastrointestinal bleeding?". Int J Colorectal Dis. 10 (4): 210–5. PMID 8568406.

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