Ren Jian-Zhuang, Zhang Meng-Fan, Rong Ai-Mei, Fang Xiang-Jie, Zhang Kai, Huang Guo-Hao, Chen Peng-Fei, Wang Zhao-Yang, Duan Xu-Hua, Han Xin-Wei, Liu Yan-Jie
Jian-Zhuang Ren, Meng-Fan Zhang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China.
World J Gastroenterol. 2015 Apr 7;21(13):4030-7. doi: 10.3748/wjg.v21.i13.4030.
To determine the value of computed tomographic angiography (CTA) for diagnosis and therapeutic planning in lower gastrointestinal (GI) bleeding.
Sixty-three consecutive patients with acute lower GI bleeding underwent CTA before endovascular or surgical treatment. CTA was used to determine whether the lower GI bleeding was suitable for endovascular treatment, surgical resection, or conservative treatment in each patient. Treatment planning with CTA was compared with actual treatment decisions or endovascular or surgical treatment that had been carried out in each patient based on CTA findings.
64-row CTA detected active extravasation of contrast material in 57 patients and six patients had no demonstrable active bleeding, resulting in an accuracy of 90.5% in the detection of acute GI bleeding (57 of 63). In three of the six patients with no demonstrable active bleeding, active lower GI bleeding recurred within one week after CTA, and angiography revealed acute bleeding. The overall location-based accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection of GI bleeding by 64-row CTA were 98.8% (249 of 252), 95.0% (57 of 60), 100% (192 of 192), 100% (57 of 57), and 98.5% (192 of 195), respectively. Treatment planning was correctly established on the basis of 64-row CTA with an accuracy, sensitivity, specificity, PPV and NPV of 98.4% (248 of 252), 93.3% (56 of 60), 100% (192 of 192), 100% (56 of 56), and 97.5% (192 of 196), respectively, in a location-based evaluation.
64-row CTA is safe and effective in making decisions regarding treatment, without performing digital subtraction angiography or surgery, in the majority of patients with lower GI bleeding.
确定计算机断层血管造影（CTA）在诊断和治疗计划制定中对下消化道（GI）出血的价值。
63例连续的急性下消化道出血患者在进行血管内或手术治疗前接受了CTA检查。CTA用于确定每位患者的下消化道出血是否适合血管内治疗、手术切除或保守治疗。将基于CTA的治疗计划与根据CTA结果在每位患者中实际做出的治疗决策或已进行的血管内或手术治疗进行比较。
64排CTA在57例患者中检测到造影剂的活动性外渗，6例患者未显示活动性出血，急性消化道出血检测的准确率为90.5%（63例中的57例）。在6例未显示活动性出血的患者中，有3例在CTA检查后1周内再次出现活动性下消化道出血，血管造影显示为急性出血。64排CTA检测消化道出血的总体基于位置的准确率、敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为98.8%（252例中的249例）、95.0%（60例中的57例）、100%（192例中的192例）、100%（57例中的57例）和98.5%（195例中的192例）。在基于位置的评估中，基于64排CTA正确制定治疗计划的准确率、敏感性、特异性、PPV和NPV分别为98.4%（252例中的248例）、93.3%（60例中的56例）、100%（192例中的192例）、100%（56例中的56例）和97.5%（196例中的192例）。
对于大多数下消化道出血患者，64排CTA在不进行数字减影血管造影或手术的情况下，在做出治疗决策方面是安全有效的。
