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Improved Detection and Localization of Lower Gastrointestinal Hemorrhage Using Subtraction Scintigraphy: Clinical Evaluation

School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia

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

Does subtraction scintigraphy improve the diagnostic utility of scintigraphic evaluation in acute lower gastrointestinal hemorrhage? Methods: This research was a retrospective clinical study using a repeat-measures design of randomized control and experimental groups. A single patient dataset provided both the control group (conventional scintigraphy) and the experimental group (conventional and subtraction techniques). Forty-nine raw ^99mTc-red blood cell studies were randomized and interpreted by 4 independent physicians as conventional scintigraphy data only (round 1). The conventional scintigraphy studies were combined with subtraction images and randomized for reinterpretation (round 2). Results: Although there was a decrease in the mean, no statistically significant difference was noted between the mean time to bleed detection between interpretive rounds 1 and 2 (P = 0.524). The addition of subtraction scintigraphy to the interpretation process changed the outcome from "probably present" to "absent" for 14% of patients and from "equivocal" to "absent" for another 12%, and this change had a marked effect on the false-positive rate. The false-positive rate decreased from 9.6% in round 1 to 3.6% in round 2. Receiver operator characteristic analysis showed that combining conventional scintigraphy with subtraction scintigraphy improved test performance. Conclusion: False-positive studies can be reduced by using subtraction scintigraphy in conjunction with conventional scintigraphy in the interpretive process.

Key Words: bowel hemorrhage; gastrointestinal tract bleeding; subtraction scintigraphy; localization; lower gastrointestinal hemorrhage