Division of Gastroenterology and Hepatology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
Int J Colorectal Dis. 2013 Aug;28(8):1099-105. doi: 10.1007/s00384-013-1658-0. Epub 2013 Feb 14.
Optimal management of acute gastrointestinal (GI) bleeding requires accurate localization of the bleeding source. The role of technetium-labeled erythrocyte scintigraphy (tagged red blood cell (TRBC) scan) in evaluating acute GI bleeding has been controversial, though recent literature suggests that it is a reliable tool and may be used as a first-line diagnostic test. We evaluated our recent experience with and the clinical outcomes of the TRBC scan in patients presenting with acute GI bleeding.
A retrospective study of 100 consecutive TRBC scans performed between April 2006 and January 2009 was conducted. Medical records of each corresponding patient were queried for pertinent data. Twenty TRBC scans performed for occult GI bleeding or >48 h after hospital admission were excluded.
Of the 80 TRBC scans, 29 (36%) were positive and 51 (64%) were negative for bleeding. Eight (10%) were incorrect positive (leading to five incorrect operations), 12 (15%) true positive, 9 (11%) unconfirmed positive, 17 (21%) false negative, and 34 (43%) unconfirmed negative. The cause of bleeding was confirmed in 31 cases, of which the scan result was incorrect positive in 2 (7%), true positive in 12 (39%), and false negative in 17 (55%).
TRBC scans have low positive yield as well as high incorrect positive and high false negative rates in patients with acute GI bleeding. Further research is needed to improve scan technique, refine patient selection, and determine in what setting TRBC scanning may be more clinically useful.
急性胃肠道（GI）出血的最佳治疗方法需要准确确定出血源。锝标记红细胞闪烁扫描术（标记红细胞（TRBC）扫描）在评估急性 GI 出血中的作用一直存在争议，尽管最近的文献表明它是一种可靠的工具，并且可作为一线诊断测试。我们评估了我们最近在急性 GI 出血患者中使用 TRBC 扫描的经验以及 TRBC 扫描的临床结果。
对 2006 年 4 月至 2009 年 1 月期间进行的 100 例连续 TRBC 扫描进行了回顾性研究。对每位患者的相应病历进行了查询，以获取相关数据。排除了 20 例用于隐匿性 GI 出血或入院后 >48 小时的 TRBC 扫描。
在 80 例 TRBC 扫描中，29 例（36%）为阳性，51 例（64%）为阴性。有 8 例（10%）为错误阳性（导致 5 例错误手术），12 例（15%）为真阳性，9 例（11%）为未确认阳性，17 例（21%）为假阴性，34 例（43%）为未确认阴性。31 例出血原因得到确认，扫描结果错误阳性 2 例（7%），真阳性 12 例（39%），假阴性 17 例（55%）。
TRBC 扫描在急性 GI 出血患者中的阳性检出率较低，错误阳性率和假阴性率较高。需要进一步研究以改善扫描技术，完善患者选择，并确定在何种情况下 TRBC 扫描可能更具临床意义。
