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Noninvasive Evaluation of Active Lower Gastrointestinal Bleeding: Comparison Between Contrast-Enhanced MDCT and 99mTc-Labeled RBC Scintigraphy

Stephen I. Zink1,2,3, Stephen K. Ohki1, Barry Stein1, Domenic A. Zambuto1, Ronald J. Rosenberg1, Jenny J. Choi4 and Daniel S. Tubbs1

1 Department of Radiology, Hartford Hospital, Hartford, CT.
2 Department of Radiology, Duke University Medical Center, Durham, NC.
3 Present address: Department of Radiology, University of Connecticut–St. Francis Hospital and Medical Center, 1000 Asylum Ave., 3201E, Hartford, CT 06105.
4 Department of Surgery, University of Connecticut School of Medicine, Farmington, CT.


Figure 1
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  		Fig. 1 —Diagram shows active lower gastrointestinal bleeding protocol. Fifty-five of 94 patients identified with active lower gastrointestinal bleeding were imaged in the study with 60 contrast-enhanced MDCT examinations performed in 55 patients. There were 41 cases with contrast-enhanced MDCT matched with 99mTc-labeled RBC scanning. Eighteen patients from these matched cases underwent angiography. Twenty-three angiography examinations were performed in total, with five patients going directly to angiography after contrast-enhanced MDCT.

 

Figure 2
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  		Fig. 2A —84-year-old woman with right axillary bifemoral arterial bypass and acute diverticular hemorrhage. Image from 5-minute planar frame at 99mTc-labeled RBC scanning shows focus of increased radiotracer activity in region of cecum (arrow).

 

Figure 3
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  		Fig. 2B —84-year-old woman with right axillary bifemoral arterial bypass and acute diverticular hemorrhage. Unenhanced axial MDCT image through level of cecum and common iliac arteries (CI).

 

Figure 4
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  		Fig. 2C —84-year-old woman with right axillary bifemoral arterial bypass and acute diverticular hemorrhage. Contrast-enhanced axial MDCT image through level of cecum and common iliac arteries shows bleeding diverticulum (arrow), enhancing axillary arterial graft (arrowhead), and occluded bilateral iliac arteries (CI).

 

Figure 5
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  		Fig. 3A —85-year-old man with acute sigmoid diverticular hemorrhage. Serial planar frames from 99mTc-labeled RBC scanning show focus of increased radiotracer activity in left lower quadrant (arrow).

 

Figure 6
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  		Fig. 3B —85-year-old man with acute sigmoid diverticular hemorrhage. Unenhanced axial MDCT image through level of sigmoid colon.

 

Figure 7
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  		Fig. 3C —85-year-old man with acute sigmoid diverticular hemorrhage. Contrast-enhanced axial MDCT image through level of sigmoid colon shows subtle diverticular hemorrhage (arrow) in case of suboptimal prolonged timing delay after contrast bolus administration. CT scan was interpreted prospectively as negative.

 

Figure 8
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  		Fig. 4A —50-year-old woman with active hemorrhage at cecum after polyp removal at colonoscopy. Patient was taken straight to angiography after CT, and bleed was successfully embolized. Unenhanced axial MDCT image through level of cecum.

 

Figure 9
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  		Fig. 4B —50-year-old woman with active hemorrhage at cecum after polyp removal at colonoscopy. Patient was taken straight to angiography after CT, and bleed was successfully embolized. Contrast-enhanced axial MDCT image through level of cecum shows that intraluminal contrast material appears relatively dilute (arrow). CT was interpreted prospectively as negative.

 

Figure 10
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  		Fig. 5A —77-year-old woman with active lower gastrointestinal hemorrhage. Unenhanced axial MDCT image through level of cecum.

 

Figure 11
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  		Fig. 5B —77-year-old woman with active lower gastrointestinal hemorrhage. Contrast-enhanced axial MDCT image through level of cecum shows active intraluminal hemorrhage at 18 hours 6 minutes (arrow).

 

Figure 12
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  		Fig. 5C —77-year-old woman with active lower gastrointestinal hemorrhage. Contrast-enhanced digitally subtracted angiography image at cecum shows blush of active hemorrhage (arrow), embolized by 18 hours 37 minutes.

 

Figure 13
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  		Fig. 6A —85-year-old woman with acute sigmoid hemorrhage associated with mass. Serial planar frames from 99mTc-labeled RBC scanning show focus of increased tracer activity in right lower quadrant (arrow).

 

Figure 14
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  		Fig. 6B —85-year-old woman with acute sigmoid hemorrhage associated with mass. Unenhanced axial MDCT image through level of sigmoid colon.

 

Figure 15
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  		Fig. 6C —85-year-old woman with acute sigmoid hemorrhage associated with mass. Contrast-enhanced axial MDCT image through level of sigmoid colon shows refluxing hemorrhage (arrow). More distally at rectal sigmoid junction, there is large soft-tissue attenuation mass (arrowhead).

 

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