Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Abdominal Radiology
Published in: Abdominal Radiology 4/2014

01-08-2014

Diagnostic ability of 99mTc-HSA-DTPA scintigraphy in combination with SPECT/CT for gastrointestinal bleeding

Authors: Kohei Kotani, Joji Kawabe, Shigeaki Higashiyama, Atsushi Yoshida, Etsushi Kawamura, Hideki Kawahata, Takashi Yamanaga, Yutaka Katayama, Susumu Shiomi

Published in: Abdominal Radiology | Issue 4/2014

Login to get access

Abstract

Purpose

Gastrointestinal (GI) bleeding scintigraphy in combination with single-photon emission computed tomography/computed tomography (SPECT/CT) remains to be studied in detail. This study aimed to examine the diagnostic ability of this tool.

Methods

GI bleeding scintigraphy using 99mTc-human serum albumin-diethylenetriaminepentaacetic acid was performed for 38 patients with suspected GI bleeding. Twenty-four patients were diagnosed using planar images alone (planar group) and 14 patients were diagnosed using planar images and additional SPECT/CT images (planar + SPECT/CT group). The diagnostic ability of each method was analyzed.

Results

GI bleeding was observed in 20 of the 38 patients. For the existence of GI bleeding, planar images alone showed a sensitivity of 70%, specificity of 93%, positive predictive value (PPV) of 88%, negative predictive value (NPV) of 81%, and an overall accuracy of 83%, whereas planar images + SPECT/CT showed a sensitivity of 100%, specificity of 75%, PPV of 91%, NPV of 100%, and an overall accuracy of 93%. The source of bleeding was accurately diagnosed in 50% in the planar group and 78% in the planar + SPECT/CT group. In the planar + SPECT/CT group, 44% of the evaluable patients showed correct localization of the source of GI bleeding by additional SPECT/CT images, although planar images only showed incorrect localization.

Conclusion

GI bleeding scintigraphy in combination with SPECT/CT is a noninvasive and useful tool for the examination of GI bleeding.
Literature
1.
Pasha SF, Leighton JA, Das A, et al. (2008) Double-balloon enteroscopy and capsule endoscopy have comparable diagnostic yield in small-bowel disease: a meta-analysis. Clin Gastroenterol Hepatol 6:671–676PubMedCrossRef
2.
Mitchell SH, Schaefer DC, Dubagunta S (2004) A new view of occult and obscure gastrointestinal bleeding. Am Fam Physician 69:875–881PubMed
3.
Liu K, Kaffes AJ (2011) Review article: the diagnosis and investigation of obscure gastrointestinal bleeding. Aliment Pharmacol Ther 34:416–423PubMedCrossRef
4.
Fukumoto A, Tanaka S, Shishido T, et al. (2009) Comparison of detectability of small-bowel lesions between capsule endoscopy and double-balloon endoscopy for patients with suspected small-bowel disease. Gastrointest Endosc 69:857–865PubMedCrossRef
5.
Yamamoto H, Kita H, Sunada K, et al. (2004) Clinical outcomes of double-balloon endoscopy for the diagnosis and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol 2:1010–1016PubMedCrossRef
6.
Liao Z, Gao R, Xu C, Li ZS (2010) Indications and detection, completion, and retention rates of small-bowel capsule endoscopy: a systematic review. Gastrointest Endosc 71:280–286PubMedCrossRef
7.
Mensink PB, Haringsma J, Kucharzik T, et al. (2007) Complications of double balloon enteroscopy: a multicenter survey. Endoscopy 39:613–615PubMedCrossRef
8.
Smith R, Copely DJ, Bolen FH (1987) 99mTc RBC scintigraphy: correlation of gastrointestinal bleeding rates with scintigraphic findings. AJR Am J Roentgenol 148:869–874PubMedCrossRef
9.
Thorne DA, Datz FL, Remley K, Christian PE (1987) Bleeding rates necessary for detecting acute gastrointestinal bleeding with technetium-99m-labeled red blood cells in an experimental model. J Nucl Med 28:514–520PubMed
10.
O’Neill BB, Gosnell JE, Lull RJ, et al. (2000) Cinematic nuclear scintigraphy reliably directs surgical intervention for patients with gastrointestinal bleeding. Arch Surg 135:1076–1081 (discussion 1081–1082)PubMedCrossRef
11.
Seto H, Kageyama M, Wu YW, et al. (1995) Sequential subtraction scintigraphy with 99mTc-RBC for the early detection of gastrointestinal bleeding. Ann Nucl Med 9:203–208PubMedCrossRef
12.
Förster GJ, Laumann C, Nickel O, et al. (2003) SPET/CT image co-registration in the abdomen with a simple and cost-effective tool. Eur J Nucl Med Mol Imaging 30:32–39PubMedCrossRef
13.
Ketai L, Hartshorne M (2001) Potential uses of computed tomography-SPECT and computed tomography-coincidence fusion images of the chest. Clin Nucl Med 26:433–441PubMedCrossRef
14.
Schillaci O, Filippi L, Danieli R, Simonetti G (2007) Single-photon emission computed tomography/computed tomography in abdominal diseases. Semin Nucl Med 37:48–61PubMedCrossRef
15.
Schillaci O, Spanu A, Tagliabue L, et al. (2009) SPECT/CT with a hybrid imaging system in the study of lower gastrointestinal bleeding with technetium-99m red blood cells. Q J Nucl Med Mol Imaging 53:281–289PubMed
16.
Zink SI, Ohki SK, Stein B, et al. (2008) Noninvasive evaluation of active lower gastrointestinal bleeding: comparison between contrast-enhanced MDCT and 99mTc-labeled RBC scintigraphy. AJR Am J Roentgenol 191:1107–1114PubMedCrossRef
17.
Kuhle WG, Sheiman RG (2003) Detection of active colonic hemorrhage with use of helical CT: findings in a swine model. Radiology 228:743–752PubMedCrossRef
18.
Wang Z, Chen JQ, Liu JL, et al. (2013) CT enterography in obscure gastrointestinal bleeding: a systematic review and meta-analysis. J Med Imaging Radiat Oncol 57:263–273PubMedCrossRef
19.
Wiarda BM, Heine DG, Mensink P, et al. (2012) Comparison of magnetic resonance enteroclysis and capsule endoscopy with balloon-assisted enteroscopy in patients with obscure gastrointestinal bleeding. Endoscopy 44:668–673PubMedCrossRef
20.
Howarth DM (2006) The role of nuclear medicine in the detection of acute gastrointestinal bleeding. Semin Nucl Med 36:133–146PubMedCrossRef
21.
Mizuno S, Ikehira H, Aoki T, et al. (1998) Occult intestinal bleeding imaged by technetium-99m-HSA-D radionuclide angiography: a case report. J Nucl Med Technol 26:30–31PubMed
22.
Ha-Kawa S, Yoshida T, Aoki Y, et al. (2002) Localization of gastrointestinal bleeding using Tc-99m HSA-DTPA SPECT and maximum-intensity projection imaging. Clin Nucl Med 27:667–669PubMedCrossRef
23.
Harvey MH, Neoptolemos JP, Watkin EM, et al. (1985) Technetium labelled red blood cell scintigraphy in the diagnosis of intestinal haemorrhage. Ann R Coll Surg Engl 67:89–92PubMedCentralPubMed
24.
Rantis PC Jr, Harford FJ, Wagner RH, Henkin RE (1995) Technetium-labelled red blood cell scintigraphy: is it useful in acute lower gastrointestinal bleeding? Int J Colorectal Dis 10:210–215PubMedCrossRef
25.
Kawabe J, Higashiyama S, Torii K, et al. (2003) Poor labeling of Tc-99m red blood cells in vivo in a radionuclide intestinal bleeding study of a patient who had recently undergone frequent blood transfusions. Clin Nucl Med 28:911–912PubMedCrossRef
26.
Yamamoto Y, Nishiyama Y (2012) SPECT/CT imaging in 99mTc-HSA-DTPA gastrointestinal bleeding scintigraphy to localize bleeding sites. Eur J Nucl Med Mol Imaging 39:1824–1825PubMedCrossRef
27.
Nagai T, Fujiyoshi K, Takahashi K, et al. (2003) Ileal schwannoma in which blood loss scintigraphy was useful for diagnosis. Intern Med 42:1178–1182PubMedCrossRef
28.
Suzman MS, Talmor M, Jennis R, et al. (1996) Accurate localization and surgical management of active lower gastrointestinal hemorrhage with technetium-labeled erythrocyte scintigraphy. Ann Surg 224:29–36PubMedCentralPubMedCrossRef
29.
Currie GM, Kiat H, Wheat JM (2011) Scintigraphic evaluation of acute lower gastrointestinal hemorrhage: current status and future directions. J Clin Gastroenterol 45:92–99PubMedCrossRef
30.
31.
Hunter JM, Pezim ME (1990) Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleeding. Am J Surg 159:504–506PubMedCrossRef
32.
Brunnler T, Klebl F, Mundorff S, et al. (2008) Significance of scintigraphy for the localisation of obscure gastrointestinal bleedings. World J Gastroenterol 14:5015–5019PubMedCentralPubMedCrossRef
33.
Howarth DM, Tang K, Lees W (2002) The clinical utility of nuclear medicine imaging for the detection of occult gastrointestinal haemorrhage. Nucl Med Commun 23:591–594PubMedCrossRef
34.
Wu Y, Seto H, Shimizu M, et al. (1997) Sequential subtraction scintigraphy with 99Tcm-RBC for the early detection of gastrointestinal bleeding and the calculation of bleeding rates: phantom and animal studies. Nucl Med Commun 18:129–138PubMedCrossRef
35.
El-Shirbiny A, Fernandez R, Zuckier LS (1995) Premature extravasation. A bleeding site identified during the dynamic phase of Tc-99m red blood cell bleeding scintigraphy. Clin Nucl Med 20:691–694PubMedCrossRef
36.
Olds GD, Cooper GS, Chak A, et al. (2005) The yield of bleeding scans in acute lower gastrointestinal hemorrhage. J Clin Gastroenterol 39:273–277PubMedCrossRef
Metadata
Title
Diagnostic ability of 99mTc-HSA-DTPA scintigraphy in combination with SPECT/CT for gastrointestinal bleeding
Authors
Kohei Kotani
Joji Kawabe
Shigeaki Higashiyama
Atsushi Yoshida
Etsushi Kawamura
Hideki Kawahata
Takashi Yamanaga
Yutaka Katayama
Susumu Shiomi
Publication date
01-08-2014
Publisher
Springer US
Published in
Abdominal Radiology / Issue 4/2014
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-014-0111-3

Other articles of this Issue 4/2014

Abdominal Radiology 4/2014 Go to the issue

Erratum

Erratum to: ACR appropriateness criteria® imaging of mesenteric ischemia

OriginalPaper

High-resolution T1-weighted gradient echo imaging for liver MRI using parallel imaging at high-acceleration factors

OriginalPaper

MR imaging in the characterization of small renal masses

Review Paper

Cross-sectional imaging of perforated gallbladder

Review Paper

From esophagus to rectum: a comprehensive review of alimentary tract perforations at computed tomography

Pictorial Essay

Contrast-enhanced CT and MR imaging of renal vessels
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits