Kim Se Hyung
J Korean Soc Radiol. 2023 May;84(3):520-535. doi: 10.3348/jksr.2022.0174. Epub 2023 May 26.
Gastrointestinal (GI) bleeding is not a single disease but a symptom and clinical manifestation of a broad spectrum of conditions in the GI tract. According to its clinical presentation, GI bleeding can be classified into overt, occult, and obscure types. Additionally, it can be divided into upper and lower GI bleeding based on the Treitz ligament. Variable disease entities, including vascular lesions, polyps, neoplasms, inflammation such as Crohn's disease, and heterotopic pancreatic or gastric tissue, can cause GI bleeding. CT and conventional angiographies and nuclear scintigraphy are all radiologic imaging modalities that can be used to evaluate overt bleeding. For the work-up of occult GI bleeding, CT enterography (CTE) can be the first imaging modality. For CTE, an adequate bowel distention is critical for obtaining acceptable diagnostic performance as well as minimizing false positives and negatives. Meckel's scintigraphy can be complementarily useful in cases where the diagnosis of CTE is suboptimal. For the evaluation of obscured GI bleeding, various imaging modalities can be used based on clinical status and providers' preferences.
胃肠道(GI)出血并非单一疾病,而是胃肠道广泛病症的一种症状和临床表现。根据其临床表现,GI出血可分为显性、隐性和不明原因型。此外,根据Treitz韧带,GI出血可分为上消化道出血和下消化道出血。多种疾病实体,包括血管病变、息肉、肿瘤、如克罗恩病的炎症以及异位胰腺或胃组织,均可导致GI出血。CT、传统血管造影和核素闪烁显像都是可用于评估显性出血的放射成像方式。对于隐性GI出血的检查,CT小肠造影(CTE)可以作为首选成像方式。对于CTE而言,充分的肠道扩张对于获得可接受的诊断性能以及最大限度减少假阳性和假阴性至关重要。在CTE诊断效果欠佳的情况下,梅克尔扫描可能会起到辅助作用。对于不明原因GI出血的评估,可根据临床状况和医疗人员的偏好使用多种成像方式。