Abstract
Radionuclide scintigraphy is commonly utilized as a screening examination before performing more invasive procedures in the work-up of patients with lower gastrointestinal (GI) bleeding. We reviewed our institutional experience with technetium-labelled red blood cell scintigraphy (TRCS) in detecting and localising acute lower GI bleeding. The study group included 72 patients who had 80 red cell scans over a five year period. Thirty-eight scans were positive (47.5%), and 42 were negative (52.5%). Sites of lower GI bleeding were confirmed by endoscopy, arteriography, surgery and/or pathology in 22 of the 38 positive scans. There were four false-negative scans (9.5%). The overall sensitivity and specificity of TRCS in detecting lower GI bleeding was 84.6% (22/26) and 70.4% (38/54), respectively. The accuracy of localization of bleeding sites in the patients with confirmed positive scans was 72.7% (16/22). Thirty mesenteric arteriograms were performed on patients in this series. Eleven arteriograms were performed after negative TRCS; one was positive. Technetium-labelled red blood cell scintigraphy appears to be a useful screening examination for patients with lower GI bleeding who are hemodynamically stable. This may avoid the potential morbidity of arteriography in patients who are not actively bleeding.
Résumé
La scintigraphie avec des substances radio-isotopiques est d'usage courant comme examen de dépistage avant d'envisager des procédures plus invasives dans l'établissement du diagnostic de patients souffrant d'hémorragies gastro-intestinales basses (GI). Nous avons recontrôlé l'expérience que nous avons acquise dans notre institution avec des scintigraphies, à l'aide d'hématies marquées au Technetium (TRCS) dans le dépistage et la localisation des sources d'hémorragies gastro-intestinales basses. Cette étude porte sur un groupe de 72 patients qui ont subi 80 scintigraphies aux hématies marquées sur une période de 5 ans. Trente-huit scans étaient positifs (47,5%) et 42 négatifs (52,5%). Le lieu de l'hémorragie gastro-intestinale basse a été confirmé par endoscopie, artériographie, chirurgie et/ou pathologie dans 22 des 38 cas avec scintigraphie positive. Quatre scintigraphies étaient faussement négatives (9,5%). La sensibilité et la spécificité globale pour TRCS dans le dépistage d'hémorragies gastrointestinales basses et de 84,6% (22/26) et 70,4% (38/54). L'exactitude de la localisation des points de saignemenet chez nos patients dont la scintigraphie était positive est de 72,7% (16/22). Trente patients ont subi des artériographies mésentériques dans notre série, 11 artériographies ont été réalisées après des TRCS négatives: une s'est révélée positive. La scintigraphie aux hématies marquées au Technetium semble être un moyen utile de dépistage de patients hémodynamiquement stables présentant une hémorragie gastrointestinale basse. Cet examen permet d'éviter la morbidité potentielle d'une artériographie chez des sujets qui ne présentent pas un saignement actif.
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Rantis, P.C., Harford, F.J., Wagner, R.H. et al. Technetium-labelled red blood cell scintigraphy: is it useful in acute lower gastrointestinal bleeding?. Int J Colorect Dis 10, 210–215 (1995). https://doi.org/10.1007/BF00346221
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DOI: https://doi.org/10.1007/BF00346221