CTA measurements of acute lower gastrointestinal bleeding size predict subsequent positive catheter angiography

Hsu, Michael; Shah, Nupur; Bernal-Fernandez, Marina; HonShideler, Curtis; Soto, Jorge A.; Anderson, Stephan W.; Ramalingam, Vijay

doi:10.1007/s00261-019-02386-5

Cited by 6 publications

(4 citation statements)

References 15 publications

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“…Previous studies have established that CTA is accurate in GIB localization and detection, [13][14][15][20][21][22][23][24] that lower GIB size on CTA correlates with subsequent positive catheter angiography, 25 and that not all patients with a positive localization CTA have active bleeding or undergo hemostatic therapy upon further investigation. [8][9][10][11]25,26 There are several possible explanations for why only a minority of bleeds identified on CTA are found intraprocedurally. First, GIB may be intermittent.…”

Section: Discussionmentioning

confidence: 99%

“…16 Second, 3 significant pitfalls hamper measurements of extravasation volume expansion between arterial and delayed phase images. 25 (1) Bleeding rate would be overestimated because delayed phase extravasation volume increases by diffusion of intraluminal contrast. (2) Diffusion would result in decreased extravasation attenuation, which would limit the ability of segmentation software to accurately differentiate contrast from the rest of the bowel contents.…”

Section: Discussionmentioning

confidence: 99%

“…First, previous mathematical models have shown that bleeding rate is best calculated from a single phase; the start of contrast administration to arterial phase acquisition most accurately captures time elapsed 16 . Second, 3 significant pitfalls hamper measurements of extravasation volume expansion between arterial and delayed phase images 25 . (1) Bleeding rate would be overestimated because delayed phase extravasation volume increases by diffusion of intraluminal contrast.…”

Section: Discussionmentioning

confidence: 99%

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Extravasation Volume at Computed Tomography Angiography Correlates With Bleeding Rate and Prognosis in Patients With Overt Gastrointestinal Bleeding

Tse

Shen²,

Shah

et al. 2021

Invest Radiol

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Objective: Despite the identification of active extravasation on computed tomography angiography (CTA) in patients with overt gastrointestinal bleeding (GIB), a large proportion do not have active bleeding or require hemostatic therapy at endoscopy, catheter angiography, or surgery. The objective of our proof-of-concept study was to improve triage of patients with GIB by correlating extravasation volume of first-pass CTA with bleeding rate and clinical outcomes. Materials and Methods: All patients who presented with overt GIB and active extravasation on CTA from January 2014 to July 2019 were reviewed in this retrospective, institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study. Extravasation volume was assessed using 3-dimensional software and correlated with hemostatic therapy (primary endpoint) and with intraprocedural bleeding, blood transfusions, and mortality as secondary endpoints using logistic regression models (P < 0.0125 indicating statistical significance). Odds ratios were used to determine the effect size of a threshold extravasation volume. Quantitative data (extravasation volume, aorta attenuation, extravasation attenuation and time) were input into a mathematical model to calculate bleeding rate. Results: Fifty consecutive patients including 6 (12%) upper, 18 (36%) small bowel, and 26 (52%) lower GIB met inclusion criteria. Forty-two underwent catheter angiography, endoscopy, or surgery; 16 had intraprocedural active bleeding, and 24 required hemostatic therapy. Higher extravasation volumes correlated with hemostatic therapy (P = 0.007), intraprocedural active bleeding (P = 0.003), and massive transfusion (P = 0.0001), but not mortality (P = 0.936). Using a threshold volume of 0.80 mL or greater, the odds ratio of hemostatic therapy was 8.1 (95% confidence interval, 2.1-26), active bleeding was 11.8 (2.6-45), and massive transfusion was 18 (2.3-65). With mathematical modeling, extravasation volume had a direct and linear relationship with bleeding rate, and the lowest calculated detectable bleeding rate with CTA was less than 0.1 mL/min. Conclusions: Larger extravasation volumes correlate with higher bleeding rates and may identify patients who require hemostatic therapy, have intraprocedural bleeding, and require blood transfusions. Current CTAs can detect bleeding rates less than 0.1 mL/min.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Extravasation Volume at Computed Tomography Angiography Correlates With Bleeding Rate and Prognosis in Patients With Overt Gastrointestinal Bleeding

Tse

Shen²,

Shah

et al. 2021

Invest Radiol

View full text Add to dashboard Cite

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“…Furthermore, a large portion of GIB cases detected by CTA are occult on catheter angiography[ 21 ]. The identification of GIB cases which are more likely to benefit from TAE based on CTA parameters other than positivity could thereby be beneficial for patient management[ 22 ].…”

Section: Introductionmentioning

confidence: 99%

Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding: A useful predictor of positive angiographic findings

Cacioppa,

Floridi,

Bruno

et al. 2024

World J Radiol

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BACKGROUND Gastrointestinal bleeding (GIB) is a severe and potentially life-threatening condition, especially in cases of delayed treatment. Computed tomography angiography (CTA) plays a pivotal role in the early identification of upper and lower GIB and in the prompt treatment of the haemorrhage. AIM To determine whether a volumetric estimation of the extravasated contrast at CTA in GIB may be a predictor of subsequent positive angiographic findings. METHODS In this retrospective single-centre study, 35 patients (22 men; median age 69 years; range 16-92 years) admitted to our institution for active GIB detected at CTA and further submitted to catheter angiography between January 2018 and February 2022 were enrolled. Twenty-three (65.7%) patients underwent endoscopy before CTA. Bleeding volumetry was evaluated in both arterial and venous phases via a semi-automated dedicated software. Bleeding rate was obtained from volume change between the two phases and standardised for unit time. Patients were divided into two groups, according to the angiographic signs and their concordance with CTA. RESULTS Upper bleeding accounted for 42.9% and lower GIB for 57.1%. Mean haemoglobin value at the admission was 7.7 g/dL. A concordance between positive CTA and direct angiographic bleeding signs was found in 19 (54.3%) cases. Despite no significant differences in terms of bleeding volume in the arterial phase (0.55 mL vs 0.33 mL, P = 0.35), a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography (2.06 mL vs 0.9 mL, P = 0.02). In the latter patient group, a significant increase in bleeding rate was also detected (2.18 mL/min vs 0.19 mL/min, P = 0.02). CONCLUSION In GIB of any origin, extravasated contrast volumetric analysis at CTA could be a predictor of positive angiography and may help in avoiding further unnecessary procedures.

CTA measurements of acute lower gastrointestinal bleeding size predict subsequent positive catheter angiography

Cited by 6 publications

References 15 publications

Extravasation Volume at Computed Tomography Angiography Correlates With Bleeding Rate and Prognosis in Patients With Overt Gastrointestinal Bleeding

Extravasation Volume at Computed Tomography Angiography Correlates With Bleeding Rate and Prognosis in Patients With Overt Gastrointestinal Bleeding

Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding: A useful predictor of positive angiographic findings

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