As the complexity of procedures and patients increases, the demand for anesthesia support in interventional radiology rises. As novel techniques are being developed, anesthesiologists must be mindful of the increased complication rate in interventional radiology and work in a multidisciplinary approach to improve patient safety.

Imaging Institute, Cleveland clinic, Cleveland, OH Purpose: To estimate the accuracy of flow images of Technetium-99m-labeled red blood cell (Tc99m-RBC) scintigraphy in predicting extravasation in subsequent catheter directed mesenteric angiogram among patients with acute gastrointestinal (GI) bleeding. Materials and Methods: Between January 2013 and August 2014, 173 scintigraphies performed on 145 patients suspected of GI bleed were retrospectively analyzed. Scintigraphy comprised of two phases -blood flow images (1s/image for 1min) followed by dynamic images (60s/image for 60 min). Scintigraphy was considered positive if there was a focus of increased activity that changes in location and increase in intensity over time in either phases. 42 patients (24%) had positive scintigraphy. Among the 29 patients who underwent subsequent angiogram within 24 hours of scintigraphy (18 male and 11 female; mean age of 67.9 years, SD 17.1; range 4 to 88), extravasation was seen in 7 (24%). These patients (n¼29) were divided into two groups for comparison. Group 1 (n¼13) comprised of patients with positive flow phase and positive dynamic phase. Group 2 (n¼16) comprised of patients with negative flow phase but positive dynamic phase. Fisher's exact test was used to compare the two groups. There were no patients with positive flow phase but negative dynamic phase. Results: During angiogram, extravasation was seen in 46% of patients in group 1 and 0% in group 2. In predicting extravasation, independent interpretation of flow phase scintigraphy using angiogram as the standard has a sensitivity and negative predictive value (NPV) of 100% each. Specificity was 69.5% and the positive predictive value (PPV) was 46.1%. Conclusion: 76% of patients with positive Tc99m-RBC scintigraphy experience no extravasation during a subsequent angiogram. Among these patients, a negative flow phase scintigraphy accurately identifies those who may not benefit from an angiogram in spite of a positive dynamic phase, likely due to very slow nature of the bleed that is not seen on angiogram. A positive flow phase and positive dynamic phase increases the chance of identifying extravasation. 3:48 PM Abstract No. 218Predicting positive angiograms by 99mTc-red blood cell (RBC) scintigraphy in patients with lower GI hemorrhage: time to positivity Purpose: To determine if the time interval from injection of 99mTc-labeled red blood cells to detectable accumulation of radiotracer activity (radionuclide "blush") in a positive scan is predictive of a positive angiogram for active GI hemorrhage. Materials and Methods: An IRB-approved retrospective study was conducted on all patients at our institution with lower GI bleeding that underwent mesenteric angiography after RBC scintigraphy study over a 12-year period. Time to positivity was determined by consensus among three radiologists on all positive studies. Determination of cut-offs for statistical analysis was performed ROC curve analysis.Results: One hundred thirty-six (135) patients with suspected or confirmed lo...

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