Ko H S, Tesdal K, Dominguez E, Kaehler G, Sadick M, Düber C, Diehl S
INF 153, Heidelberg.
Rofo. 2005 Dec;177(12):1649-54. doi: 10.1055/s-2005-858492.
There is no gold-standard regarding the diagnostic work-up and therapy of an acute gastrointestinal (GI) hemorrhage. In most cases endoscopy provides the diagnosis but in a low percentage this modality is not feasible or negative. Purpose of this study was to evaluate the role of multi-phase Multi-Slice-Computertomography (MSCT) as a modality to diagnose and locate the site of acute GI hemorrhage in case of unfeasible or technically difficult endoscopy.
58 patients, presenting with clinical signs of lower GI hemorrhage, were examined through a 24-month period. Preliminary endoscopy was either negative or unfeasible. Images were obtained with a four-detector row CT with an arterial (4 x 1 mm collimation, 0.8 mm increment, 1.25 mm slice width, 120 kV, 165 mAs) and portal venous series (4 x 2,5 mm collimation, 2 mm increment, 3 mm slice width, 120 kV, 165 mAs). Time interval between endoscopy and CT varied between 30 minutes and 3 hours. The results of the MSCT were correlated with clinical course and surgical or endoscopical treatment.
20 of the 58 patients (34 %) undergoing MSCT had a bleeding site identified, thus providing decisive information for the following intervention. In case of a following therapeutic intervention there was 100 % correlation regarding the bleeding site. In 38 of the 58 patients (66 %), a bleeding site was not identified by MSCT. Twenty of these 38 patients (53 %) were stable and required no further treatment. In 18 of these 38 patients further interventional therapy was required due to continuing hemorrhage and in all of those patients the bleeding site was detected by intervention.
Compared to other diagnostic methods MSCT is a fast, widely-available and low-risk technique for the localization of active GI hemorrhage. The clinical use seems to be justified since in more than one third of the patients, MSCT demonstrates the site of bleeding and provides decisive information for further interventional therapy. Concerning those patients, in whom MSCT is negative (38 out of 58 patients), only every second patient requires any additional diagnostic work-up.
急性胃肠道出血的诊断检查和治疗尚无金标准。在大多数情况下，内镜检查可明确诊断，但在少数情况下，这种检查方式不可行或结果为阴性。本研究的目的是评估多期多层螺旋计算机断层扫描（MSCT）在不可行或技术上困难的内镜检查情况下，作为诊断和定位急性胃肠道出血部位的一种方式的作用。
对58例有下消化道出血临床症状的患者进行了为期24个月的检查。初步内镜检查结果为阴性或不可行。使用四排探测器CT获取图像，包括动脉期（准直4×1mm，层厚0.8mm，层间距1.25mm，管电压120kV，管电流165mAs）和门静脉期（准直4×2.5mm，层厚2mm，层间距3mm，管电压120kV，管电流165mAs）。内镜检查与CT检查的时间间隔在30分钟至3小时之间。将MSCT的结果与临床病程以及手术或内镜治疗情况进行关联。
58例行MSCT检查的患者中有20例（34%）确定了出血部位，从而为后续干预提供了决定性信息。在后续进行治疗性干预的情况下，出血部位的相关性为100%。58例患者中有38例（66%）MSCT未发现出血部位。这38例患者中有20例（53%）病情稳定，无需进一步治疗。这38例患者中有18例因持续出血需要进一步的介入治疗，且所有这些患者的出血部位均通过介入治疗被发现。
与其他诊断方法相比，MSCT是一种快速、广泛可用且风险较低的用于定位活动性胃肠道出血的技术。其临床应用似乎是合理的，因为在超过三分之一的患者中，MSCT可显示出血部位并为进一步的介入治疗提供决定性信息。对于MSCT结果为阴性的患者（58例中有38例），仅每例患者需要进行额外的诊断检查。
