Lower gastrointestinal bleeding CT scan: Difference between revisions
Jump to navigation
Jump to search
Aditya Ganti (talk | contribs) |
No edit summary |
||
| (8 intermediate revisions by one other user not shown) | |||
| Line 3: | Line 3: | ||
{{CMG}}; {{AE}} {{ADG}} | {{CMG}}; {{AE}} {{ADG}} | ||
==Overview== | ==Overview== | ||
[[Helical CT scan|Helical CT scanning]] of the [[abdomen]] and [[pelvis]] is recommended when a routine workup fails to determine the cause of active gastrointestinal bleeding. Findings of helical CT scan in lower gastrointestinal bleeding include vascular [[extravasation]] of the [[contrast medium]], contrast enhancement of the bowel wall, thickening of the bowel wall, hyperdensity of the peri-bowel fat, and vascular dilatations. | |||
==Helical CT scan== | ==Helical CT scan== | ||
Helical CT scanning of the abdomen and pelvis is | Helical CT scanning of the [[abdomen]] and [[pelvis]] is recommended when a routine workup fails to determine the cause of active gastrointestinal bleeding. Helical CT scanning is a safe, convenient, and an accurate diagnostic tool relative to [[Angiography|mesenteric angiography]] and [[colonoscopy]] in diagnosing acute lower GI bleeding (LGIB). Findings of helical CT scan in lower gastrointestinal bleeding include:<ref name="pmid27303989">{{cite journal |vauthors=Feuerstein JD, Ketwaroo G, Tewani SK, Cheesman A, Trivella J, Raptopoulos V, Leffler DA |title=Localizing Acute Lower Gastrointestinal Hemorrhage: CT Angiography Versus Tagged RBC Scintigraphy |journal=AJR Am J Roentgenol |volume=207 |issue=3 |pages=578–84 |year=2016 |pmid=27303989 |doi=10.2214/AJR.15.15714 |url=}}</ref><ref name="pmid14628865">{{cite journal |vauthors=Yamaguchi T, Yoshikawa K |title=Enhanced CT for initial localization of active lower gastrointestinal bleeding |journal=Abdom Imaging |volume=28 |issue=5 |pages=634–6 |year=2003 |pmid=14628865 |doi= |url=}}</ref> | ||
*Vascular extravasation of the contrast medium | *Vascular [[extravasation]] of the contrast medium | ||
*Contrast enhancement of the bowel wall | *Contrast enhancement of the bowel wall | ||
*Thickening of the bowel wall | *Thickening of the bowel wall | ||
* | *Hyperdensity of the peri-bowel fat, and vascular dilatations. | ||
Multidetector-row CT (MDCT) scanning is also useful in the evaluation of LGIB but its rarely used. | Multidetector-row CT (MDCT) scanning is also useful in the evaluation of LGIB but its rarely used. | ||
{| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable" | {| border="1" cellpadding="5" cellspacing="0" align="center" |class="wikitable" | ||
!style="background:#efefef;" |Sensitivity | ! style="background:#efefef;" |Sensitivity | ||
!style="background:#efefef;" |MDCT | ! style="background:#efefef;" |MDCT | ||
!style="background:#efefef;" |Endoscopy | ! style="background:#efefef;" |Endoscopy | ||
|- | |- | ||
|Site | |Site | ||
| Line 27: | Line 28: | ||
==CT Angiography== | ==CT Angiography== | ||
* | *CT Angiography is a multidetector CT scan performed in the arterial phase.<ref name="pmid21721196">{{cite journal |vauthors=Geffroy Y, Rodallec MH, Boulay-Coletta I, Jullès MC, Fullès MC, Ridereau-Zins C, Zins M |title=Multidetector CT angiography in acute gastrointestinal bleeding: why, when, and how |journal=Radiographics |volume=31 |issue=3 |pages=E35–46 |year=2011 |pmid=21721196 |doi=10.1148/rg.313105206 |url=}}</ref><ref name="pmid24025935">{{cite journal |vauthors=Artigas JM, Martí M, Soto JA, Esteban H, Pinilla I, Guillén E |title=Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings |journal=Radiographics |volume=33 |issue=5 |pages=1453–70 |year=2013 |pmid=24025935 |doi=10.1148/rg.335125072 |url=}}</ref><ref name="pmid20377709">{{cite journal |vauthors=Foley PT, Ganeshan A, Anthony S, Uberoi R |title=Multi-detector CT angiography for lower gastrointestinal bleeding: Can it select patients for endovascular intervention? |journal=J Med Imaging Radiat Oncol |volume=54 |issue=1 |pages=9–16 |year=2010 |pmid=20377709 |doi=10.1111/j.1754-9485.2010.02131.x |url=}}</ref><ref name="pmid20712058">{{cite journal |vauthors=Wu LM, Xu JR, Yin Y, Qu XH |title=Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding: a meta-analysis |journal=World J. Gastroenterol. |volume=16 |issue=31 |pages=3957–63 |year=2010 |pmid=20712058 |pmc=2923771 |doi= |url=}}</ref><ref name="pmid26811556">{{cite journal |vauthors=Reis FR, Cardia PP, D'Ippolito G |title=Computed tomography angiography in patients with active gastrointestinal bleeding |journal=Radiol Bras |volume=48 |issue=6 |pages=381–90 |year=2015 |pmid=26811556 |pmc=4725400 |doi=10.1590/0100-3984.2014.0014 |url=}}</ref> | ||
* | |||
==== Procedure ==== | |||
*[[Contrast medium|Contrast]] (100 mL) is given via peripheral venous access and a CT scan is performed 30 seconds following injection. | |||
*CT scan is then repeated in the portal phase (70 seconds following injection). | |||
*CT Angiography can detect [[bleeding]] with a rate of 0.5 mL/min or less whereas catheter angiography detects [[bleeding]] with a rate of 0.5 to 1 mL/min. Therefore, CTA is performed before catheter angiography. | |||
*Access into the arterial system is normally via a [[Femoral artery|common femoral artery]] approach. | |||
*If this is not possible, the [[brachial artery]] can be used, although this carries a small risk of [[stroke]]. | |||
*A wide range of [[catheters]] can be used to access the [[mesenteric arteries]] (majority of bleeds due to [[Diverticular disease|diverticula]] or [[angiodysplasia]] receive their blood supply from the [[superior mesenteric artery]]). | |||
*In practice, the [[inferior mesenteric artery]] is selectively catheterized before the [[superior mesenteric artery]] to avoid a [[bladder]] full of contrast obscuring the [[Inferior mesenteric artery|inferior mesenteric branches]]. | |||
*If no [[bleeding]] source is identified from these two vessels ([[Superior mesenteric artery|SMA]], [[Inferior mesenteric artery|IMA]]) the celiac axis is catheterized and assessed, as bleeding points may be discovered from the [[gastroduodenal artery]]. | |||
===Indications=== | ===Indications=== | ||
*In patients who are actively bleeding but who are relatively hemodynamically stable | *In patients who are actively bleeding but who are relatively hemodynamically stable | ||
| Line 34: | Line 44: | ||
*Noninvasive | *Noninvasive | ||
*CT Angiography can pick up findings in the solid organs and soft tissue structures that would not be seen on catheter angiography. | *CT Angiography can pick up findings in the solid organs and soft tissue structures that would not be seen on catheter angiography. | ||
*CT Angiography can potentially detect bleeding from any point in the gastrointestinal tract and may reveal an upper gastrointestinal source of bleeding in a patient thought to have LGIB. | *CT Angiography can potentially detect [[bleeding]] from any point in the [[gastrointestinal tract]] and may reveal an upper gastrointestinal source of bleeding in a patient thought to have LGIB. | ||
*CT Angiography can also help with planning embolization by revealing any iliac artery or mesenteric ostial atherosclerotic disease | *CT Angiography can also help with planning [[embolization]] by revealing any [[iliac artery]] or [[Mesenteric artery|mesenteric]] [[Ostial coronary stenosis|ostial]] [[atherosclerotic disease]]. | ||
*CTA also has the advantage that it is widely available 24 hours a day, unlike colonoscopy services in many areas. | *CTA also has the advantage that it is widely available 24 hours a day, unlike [[colonoscopy]] services in many areas. | ||
*If a patient then becomes unstable and an initial bleeding point is localized on CTA, then the choice has to be made between urgent colonoscopy, angiographic embolization, or surgery | *If a patient then becomes unstable and an initial bleeding point is localized on CTA, then the choice has to be made between urgent [[colonoscopy]], angiographic [[embolization]], or [[surgery]]. | ||
===Findings/Interpretation=== | ===Findings/Interpretation=== | ||
*Arterial phase CTA may show thrombus in the superior or inferior mesenteric artery. | *Arterial phase CTA may show [[thrombus]] in the [[Superior mesenteric artery|superior]] or [[Inferior mesenteric artery|inferior mesenteric artery.]] | ||
*CTA has a sensitivity of 93% to 100% and specificity of 100% in detecting mesenteric ischemia. | *CTA has a [[sensitivity]] of 93% to 100% and [[specificity]] of 100% in detecting [[mesenteric ischemia]]. | ||
*If CTA fails to show a source of [[bleeding]], then catheter [[angiography]] is generally not performed. | |||
*If CTA fails to show a source of bleeding, then catheter angiography is generally not performed. | *If a bleeding point is seen on CTA, then [[Angiography|catheter angiography]] and [[embolization]] can be undertaken. | ||
*If a bleeding point is seen on CTA, then catheter angiography and embolization can be undertaken | |||
===Disadvantage=== | ===Disadvantage=== | ||
*Poor sensitivity | *Poor [[sensitivity]] | ||
===Contraindications=== | ===Contraindications=== | ||
*Contraindicated in patients with renal failure as the contrast agent may potentially worsen renal function. | *Contraindicated in patients with [[renal failure]] as the contrast agent may potentially [[Contrast induced nephropathy|worsen renal function]]. | ||
==References== | ==References== | ||
Latest revision as of 19:53, 29 December 2017
|
Lower gastrointestinal bleeding Microchapters |
|
Differentiating Lower gastrointestinal bleeding from other Diseases |
|---|
|
Diagnosis |
|
Treatment |
|
Management |
|
Surgery |
|
Case Studies |
|
Lower gastrointestinal bleeding CT scan On the Web |
|
American Roentgen Ray Society Images of Lower gastrointestinal bleeding CT scan |
|
Risk calculators and risk factors for Lower gastrointestinal bleeding CT scan |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]
Overview
Helical CT scanning of the abdomen and pelvis is recommended when a routine workup fails to determine the cause of active gastrointestinal bleeding. Findings of helical CT scan in lower gastrointestinal bleeding include vascular extravasation of the contrast medium, contrast enhancement of the bowel wall, thickening of the bowel wall, hyperdensity of the peri-bowel fat, and vascular dilatations.
Helical CT scan
Helical CT scanning of the abdomen and pelvis is recommended when a routine workup fails to determine the cause of active gastrointestinal bleeding. Helical CT scanning is a safe, convenient, and an accurate diagnostic tool relative to mesenteric angiography and colonoscopy in diagnosing acute lower GI bleeding (LGIB). Findings of helical CT scan in lower gastrointestinal bleeding include:[1][2]
- Vascular extravasation of the contrast medium
- Contrast enhancement of the bowel wall
- Thickening of the bowel wall
- Hyperdensity of the peri-bowel fat, and vascular dilatations.
Multidetector-row CT (MDCT) scanning is also useful in the evaluation of LGIB but its rarely used.
| Sensitivity | MDCT | Endoscopy |
|---|---|---|
| Site | 100% | 88.2% |
| Etiology | 52.9% | 52.9% |
CT Angiography
Procedure
- Contrast (100 mL) is given via peripheral venous access and a CT scan is performed 30 seconds following injection.
- CT scan is then repeated in the portal phase (70 seconds following injection).
- CT Angiography can detect bleeding with a rate of 0.5 mL/min or less whereas catheter angiography detects bleeding with a rate of 0.5 to 1 mL/min. Therefore, CTA is performed before catheter angiography.
- Access into the arterial system is normally via a common femoral artery approach.
- If this is not possible, the brachial artery can be used, although this carries a small risk of stroke.
- A wide range of catheters can be used to access the mesenteric arteries (majority of bleeds due to diverticula or angiodysplasia receive their blood supply from the superior mesenteric artery).
- In practice, the inferior mesenteric artery is selectively catheterized before the superior mesenteric artery to avoid a bladder full of contrast obscuring the inferior mesenteric branches.
- If no bleeding source is identified from these two vessels (SMA, IMA) the celiac axis is catheterized and assessed, as bleeding points may be discovered from the gastroduodenal artery.
Indications
- In patients who are actively bleeding but who are relatively hemodynamically stable
Advantages
- Noninvasive
- CT Angiography can pick up findings in the solid organs and soft tissue structures that would not be seen on catheter angiography.
- CT Angiography can potentially detect bleeding from any point in the gastrointestinal tract and may reveal an upper gastrointestinal source of bleeding in a patient thought to have LGIB.
- CT Angiography can also help with planning embolization by revealing any iliac artery or mesenteric ostial atherosclerotic disease.
- CTA also has the advantage that it is widely available 24 hours a day, unlike colonoscopy services in many areas.
- If a patient then becomes unstable and an initial bleeding point is localized on CTA, then the choice has to be made between urgent colonoscopy, angiographic embolization, or surgery.
Findings/Interpretation
- Arterial phase CTA may show thrombus in the superior or inferior mesenteric artery.
- CTA has a sensitivity of 93% to 100% and specificity of 100% in detecting mesenteric ischemia.
- If CTA fails to show a source of bleeding, then catheter angiography is generally not performed.
- If a bleeding point is seen on CTA, then catheter angiography and embolization can be undertaken.
Disadvantage
- Poor sensitivity
Contraindications
- Contraindicated in patients with renal failure as the contrast agent may potentially worsen renal function.
References
- ↑ Feuerstein JD, Ketwaroo G, Tewani SK, Cheesman A, Trivella J, Raptopoulos V, Leffler DA (2016). "Localizing Acute Lower Gastrointestinal Hemorrhage: CT Angiography Versus Tagged RBC Scintigraphy". AJR Am J Roentgenol. 207 (3): 578–84. doi:10.2214/AJR.15.15714. PMID 27303989.
- ↑ Yamaguchi T, Yoshikawa K (2003). "Enhanced CT for initial localization of active lower gastrointestinal bleeding". Abdom Imaging. 28 (5): 634–6. PMID 14628865.
- ↑ Geffroy Y, Rodallec MH, Boulay-Coletta I, Jullès MC, Fullès MC, Ridereau-Zins C, Zins M (2011). "Multidetector CT angiography in acute gastrointestinal bleeding: why, when, and how". Radiographics. 31 (3): E35–46. doi:10.1148/rg.313105206. PMID 21721196.
- ↑ Artigas JM, Martí M, Soto JA, Esteban H, Pinilla I, Guillén E (2013). "Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings". Radiographics. 33 (5): 1453–70. doi:10.1148/rg.335125072. PMID 24025935.
- ↑ Foley PT, Ganeshan A, Anthony S, Uberoi R (2010). "Multi-detector CT angiography for lower gastrointestinal bleeding: Can it select patients for endovascular intervention?". J Med Imaging Radiat Oncol. 54 (1): 9–16. doi:10.1111/j.1754-9485.2010.02131.x. PMID 20377709.
- ↑ Wu LM, Xu JR, Yin Y, Qu XH (2010). "Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding: a meta-analysis". World J. Gastroenterol. 16 (31): 3957–63. PMC 2923771. PMID 20712058.
- ↑ Reis FR, Cardia PP, D'Ippolito G (2015). "Computed tomography angiography in patients with active gastrointestinal bleeding". Radiol Bras. 48 (6): 381–90. doi:10.1590/0100-3984.2014.0014. PMC 4725400. PMID 26811556.