Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Wangfujing Street, Beijing 100730, China.
Clin Radiol. 2013 Feb;68(2):139-47. doi: 10.1016/j.crad.2012.06.106. Epub 2012 Sep 21.
To assess the utility of dual-source dual-energy computed tomography angiography (DSDECTA) in the diagnosis of active gastrointestinal bleeding (GIB).
From June 2010 to September 2011, 58 consecutive patients with clinical signs of active GIB underwent DSDECTA. Two radiologists, blinded to clinical data, interpreted images from DSDECTA independently, with discordant interpretation resolved by consensus. The standards of reference included digital subtraction angiography, endoscopy, surgery, or final pathology reports. Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy of DSDECTA for detection of active GIB were evaluated. Receiver-operating characteristic (ROC) analysis was undertaken and the area under the curve (AUC) calculated.
Active GIB source was identified in 39 of 58 patients (67.2%), all of which were confirmed by one or more reference standard. Negative DSDECTA results were obtained in 19 patients (32.8%). Of these, 15 patients did not require any further intervention and were discharged without incident. The overall sensitivity, specificity, PPV, NPV, and accuracy of DSDECTA was 88.6, 100, 100, 73.7, and 91.4%, respectively. The AUC was 0.935 ± 0.063. The dose reduction of a dual-phase DSDECTA protocol was approximately 30%, compared with that of a triple-phase protocol used in a previous study.
DSDECTA can act as an accurate method for detection and localization of active GIB and has a relatively low radiation dose.
评估双源双能量计算机断层血管造影（DSDECTA）在诊断活动性胃肠道出血（GIB）中的应用价值。
2010 年 6 月至 2011 年 9 月，58 例有临床活动性 GIB 征象的患者连续接受了 DSDECTA 检查。两位放射科医生在不知临床数据的情况下，分别对 DSDECTA 图像进行独立解读，意见不一致时通过共识解决。参考标准包括数字减影血管造影、内镜、手术或最终病理报告。评估 DSDECTA 检测活动性 GIB 的敏感性、特异性、阳性（PPV）和阴性（NPV）预测值和准确性。进行了受试者工作特征（ROC）分析，并计算曲线下面积（AUC）。
在 58 例患者中，39 例（67.2%）确定了活动性 GIB 源，所有源均经一种或多种参考标准证实。19 例患者（32.8%）的 DSDECTA 结果为阴性。其中，15 例患者无需进一步干预，未发生任何并发症而出院。DSDECTA 的总体敏感性、特异性、PPV、NPV 和准确性分别为 88.6%、100%、100%、73.7%和 91.4%。AUC 为 0.935±0.063。与既往研究中使用的三相方案相比，双相 DSDECTA 方案的剂量降低了约 30%。
DSDECTA 可作为一种准确的方法，用于检测和定位活动性 GIB，且辐射剂量相对较低。
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