Localization of lower gastrointestinal bleeding using in vivo technetium-99m-labelled red blood cell scintigraphy

Abstract

Technetium-99m-labelled red blood cell scintigraphy was used in the investigation of 41 patients with major rectal haemorrhage. Red cells were labelled in vivo with technetium-99m pertechnetate and serial scans (0-36 h) were taken using a large field gamma camera. Twenty-two men and 15 women, mean age 71.3 years (range 32-91 years), and four children were studied. Forty-three scans were performed in all and there were 31 positive and 12 negative results. In each case the accuracy of the scan in localizing the bleeding site was checked either by independent investigations or at laparotomy. A definite bleeding site was identified in 30 cases and red cell scintigraphy correctly localized 29 of these (sensitivity 97 per cent). In the remaining 13 cases a bleeding site was not identified by any of the independent investigations and in this group there were two false positive scans (specificity 85 per cent). The investigation had a high predictive value when both positive (94 per cent) and negative (92 per cent). These data suggest that technetium-99m-labelled red cell scintigraphy should be used more widely in the investigation of patients with suspected lower gastrointestinal haemorrhage.

Predictive value of technetium Tc 99m-labeled red blood cell scintigraphy for positive angiogram in massive lower gastrointestinal hemorrhage

“…3 Technetium Tc 99m (99mTc)-labeled red blood cell (RBC) scintigraphy is a screening tool for patients with massive LGIH because it is highly sensitive and readily available and carries a low morbidity. 4 In ad-…”

Role of red blood cell scintigraphy for determining the localization of gastrointestinal bleeding

“…[14,15] Therefore, if the scintigraphy proves to be negative, there is no practical benefit in performing an angiography. [16][17][18] In addition, RBC scintigraphy may be helpful in establishing the correct timing of the angiography. [19] In the present study, angiography was performed in nine patients with negative results before referral to our center.…”

Digestive System

“…The sensitivity of this cinematic method is more than 90 % [ 33 ]. The patients can be monitored for up to 24 h; however, the site of extravasation may be easily misinterpreted [ 34 ]. A negative radionuclide study is good evidence that angiography will not detect the site of hemorrhage.…”

“…Radionuclide procedures are useful in establishing or ruling out IBD in patients with intestinal complaints, in assessing disease severity, and in the evaluation of extraintestinal septic complications [ 34 ]. Radiolabeled leukocytes studies offer an accepted radionuclide method for imaging infl ammation.…”