Tina Jaeckle MD, Presenter: Nothing to Disclose

Gregor Stuber MD, Abstract Co-Author: Nothing to Disclose

Hans-Juergen Brambs MD, Abstract Co-Author: Nothing to Disclose

Andrik Johannes Aschoff MD, Abstract Co-Author: Nothing to Disclose

To retrospectively evaluate the accuracy of multi-detector row CT (MDCT) using a contrast medium (CM) with high iodine concentration for detection and localization of upper and lower acute GI hemorrhage or intraperitoneal bleeding.

26 consecutive patients with clinical signs of acute bleeding (hypotension, need for transfusion, marked lowering of hemoglobin/hematocrit) were examined at 40-channel MDCT (Philips Brilliance 40, Cleveland, OH) or 16-channel MDCT (IDT, Philips). Arterial and portal-venous phase images were obtained after administration of a CM with high iodine concentration (400 mg/ml; Iomeron 400, Bracco, Milano, Italy). CM administration was by power injector at a dose of 1.2 ml/kg BW and at a rate of 4 ml/sec. Axial images (1 or 2 mm slice thickness), MIP and MPR reconstructions were acquired. MDCT findings were correlated with endoscopy, interventional angiography or surgery in 6, 11 and 9 patients, respectively.

Among the 26 patients evaluated, 19 were examined for GI bleeding and 7 for intraperitoneal hemorrhage. Confirmed sites of GI bleeding were stomach (n=4), duodenum (n=1), small bowel (n=7), and large bowel (n=7). The correct site of bleeding was identifiable on MDCT in 17/19 (89.5%) patients with GI bleeding. In 14 (82.4%) of these 17 patients active bleeding was apparent during the exam. In 2/19 (10.5%) patients MDCT revealed no signs of hemorrhage. Endoscopy subsequently revealed diffuse mucosal bleeding of the colon in one of these patients and duodenal invasion of a pancreatic neoplasm with bleeding in the other. In the seven patients with intraperitoneal hemorrhage MDCT correctly identified the bleeding source in 6/7 (85.7%) patients. In the remaining patient MDCT revealed no signs of acute bleeding. Angiographic follow-up of this patient revealed the bleeding source to be an erosion of the splenic artery.

Fast and accurate detection and localization of upper/lower acute GI hemorrhage and intraperitoneal bleeding is achievable on MDCT using CM with high iodine concentration.

MDCT can replace conventional angiography for workup of patients with GI or intraperitoneal bleeding.

Jaeckle, T, Stuber, G, Brambs, H, Aschoff, A, Detection and Localization of Acute Gastrointestinal (GI) Bleeding with Arterial Phase Multi-Detector Row Helical CT Using High-Concentration Contrast Media.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4435126.html