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Improved Detection and Localization of Lower Gastrointestinal Tract Hemorrhage by Subtraction Scintigraphy: Phantom Analysis

¹ School of Clinical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia; and ² School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia

Correspondence: For correspondence or reprints contact: Geoffrey M. Currie, CNMT, School of Clinical Sciences, Locked Bag 588, Charles Sturt University, Wagga Wagga, New South Wales 2678, Australia. E-mail: gcurrie{at}csu.edu.au

Acute lower gastrointestinal tract hemorrhage (LGIH) has significant morbidity and mortality outcomes. Although several causes of LGIH can be life threatening, most can be effectively treated; therefore, early detection and accurate localization of bleeding sites are critical for successful patient management. Methods: This study was a phantom experimental study with a repeated-measures design. The minimum detectable bleeding rate, the minimum detectable bleed volume, the sensitivity for detection, and the time required for detection were determined and compared for conventional scintigraphy (CS) and 3 experimental techniques: reference subtraction scintigraphy (RSS), sequential subtraction scintigraphy (SSS), and alternate sequential subtraction scintigraphy (ASSS). Results: The minimum detectable bleeding rates within the first hour were 0.05 mL·min^–1 for CS and RSS, 0.1 mL·min^–1 for ASSS, and 0.5 mL·min^–1 for SSS. This study demonstrated minimum detectable bleed volumes of 2.2 mL for CS, 2.3 mL for RSS, 5 mL for ASSS, and 5 mL for SSS stratified to a "definitely present" certainty. No statistically significant difference was noted in the mean time to detection between CS and the subtraction techniques. Receiver-operating-characteristic analysis indicated that combining CS and RSS improved test performance and increased overall sensitivity to 75% from 68.3% for CS and 71.7% for RSS. Conclusion: Supplementing conventional datasets with RSS and ASSS may provide a useful tool that combines the advantages offered for lesion detectability by a high-contrast ^99mTc-sulfur colloid study with the window of opportunity offered by ^99mTc-labeled red blood cell scanning.

Key Words: bowel hemorrhage; gastrointestinal tract bleed; subtraction scintigraphy; localization; LGIH

This article has been cited by other articles:

				G. M. Currie Cost-Effectiveness Analysis of Subtraction Scintigraphy in Patients with Acute Lower Gastrointestinal Tract Hemorrhage J. Nucl. Med. Technol., September 1, 2007; 35(3): 140 - 147. [Abstract] [Full Text] [PDF]

				G. M. Currie, P. A. Towers, and J. M. Wheat Improved Detection and Localization of Lower Gastrointestinal Hemorrhage Using Subtraction Scintigraphy: Clinical Evaluation J. Nucl. Med. Technol., June 1, 2007; 35(2): 105 - 111. [Abstract] [Full Text] [PDF]