James E. Huprich MD, Presenter: Nothing to Disclose

Joel Garland Fletcher MD, Abstract Co-Author: Nothing to Disclose

Jeffrey A. Alexander MD, Abstract Co-Author: Nothing to Disclose

Jeff Lynn Fidler MD, Abstract Co-Author: Nothing to Disclose

Darrell S. Pardi MD, Abstract Co-Author: Nothing to Disclose

Bret T. Petersen MD, Abstract Co-Author: Nothing to Disclose

Todd H. Baron MD, Abstract Co-Author: Nothing to Disclose

J.L.F.: Research support from EZ-EM, Inc.J.G.F.: Siemens Medical Solution(Grant); GE Healthcare (Educational License); EZ-EM, Inc. - CME Course

Purpose:  In the era of capsule endoscopy, studies have suggested that CT is of little added benefit in patients with obscure GI bleeding.  We sought to evaluate the performance of a timed, multi-phase, multiplanar CT enterography (CTE) protocol, performed with an isotropic spatial resolution 64 channel CT, in patients with obscure GI bleeding. Materials and Methods:  Twenty-two patients with evidence of GI blood loss (hematochezia, melena or hemoccult positive stools) and negative upper and lower endoscopies underwent CT enterography utilizing neutral enteric contrast using a 64-channel CT scanner.  Scanning was performed during each of three phases following IV contrast at: (1) peak aortic enhancement (5 s post 150 HU threshold); and (2) 20 seconds and (3) 90 seconds later.  Images were reconstructed in the axial and coronal planes (2.0 mm slice width/ 1mm intervals).  CTE findings were correlated with capsule and traditional endoscopy, surgical, and other imaging findings.  Results:  CTE was positive for active bleeding or focal bowel abnormality thought to be a bleeding source in 10/22 (45%) of cases. 9 of 10 positive CTE patients underwent capsule endoscopy (CE).  CTE correctly identified a jejunal stromal tumor, a cecal AVM (subsequently successfully embolized), and a vascular jejunal wall  mass (confirmed on a repeat CTE 5 months later), all of which were missed by CE.  12/22 patients had negative CTE’s.  Only 4 of these 12 underwent CE, with 2 having a positive CE (a jejunal lymphangioma and small bowel blood demonstrated to originate from Cameron’s ulcers in a hiatal hernia at subsequent endoscopy). CE yielded a specific diagnosis in 2/7 patients with positive CE.  CTE suggested a specific diagnosis  in 6/10 patients with positive CTE and more accurately localized the bleeding in all 10 cases. Conclusion:  Multi-phase, multiplanar CT enterography plays a complementary role with capsule endoscopy in evaluating obscure GI bleeding .  Additional prospective studies should be undertaken to further clarify its role. JGF:  Siemens Medical Solution (Grant); GE Healthcare (Educational License); EZ-EM, Inc. – CME CourseJLF:  Research support from E-Z-EM

Huprich, J, Fletcher, J, Alexander, J, Fidler, J, Pardi, D, Petersen, B, Baron, T, Hot Topic: Obscure GI Bleeding: 64 Channel Multi-phase, Multiplanar CT Enterography Has a Role.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4425788.html