胃肠道出血计算机断层血管造影中造影剂外渗的容积评估：血管造影阳性结果的有用预测指标。

Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding: A useful predictor of positive angiographic findings.

作者信息

Cacioppa Laura Maria, Floridi Chiara, Bruno Alessandra, Rossini Nicolò, Valeri Tommaso, Borgheresi Alessandra, Inchingolo Riccardo, Cortese Francesco, Novelli Giacomo, Felicioli Alessandro, Torresi Mario, Boscarato Pietro, Ottaviani Letizia, Giovagnoni Andrea

机构信息

Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy.

Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy.

出版信息

World J Radiol. 2024 May 28;16(5):115-127. doi: 10.4329/wjr.v16.i5.115.

DOI:10.4329/wjr.v16.i5.115

PMID:38845606

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11151896/

Abstract

BACKGROUND

Gastrointestinal bleeding (GIB) is a severe and potentially life-threatening condition, especially in cases of delayed treatment. Computed tomography angiography (CTA) plays a pivotal role in the early identification of upper and lower GIB and in the prompt treatment of the haemorrhage.

AIM

To determine whether a volumetric estimation of the extravasated contrast at CTA in GIB may be a predictor of subsequent positive angiographic findings.

METHODS

In this retrospective single-centre study, 35 patients (22 men; median age 69 years; range 16-92 years) admitted to our institution for active GIB detected at CTA and further submitted to catheter angiography between January 2018 and February 2022 were enrolled. Twenty-three (65.7%) patients underwent endoscopy before CTA. Bleeding volumetry was evaluated in both arterial and venous phases a semi-automated dedicated software. Bleeding rate was obtained from volume change between the two phases and standardised for unit time. Patients were divided into two groups, according to the angiographic signs and their concordance with CTA.

RESULTS

Upper bleeding accounted for 42.9% and lower GIB for 57.1%. Mean haemoglobin value at the admission was 7.7 g/dL. A concordance between positive CTA and direct angiographic bleeding signs was found in 19 (54.3%) cases. Despite no significant differences in terms of bleeding volume in the arterial phase (0.55 mL 0.33 mL, = 0.35), a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography (2.06 mL 0.9 mL, = 0.02). In the latter patient group, a significant increase in bleeding rate was also detected (2.18 mL/min 0.19 mL/min, = 0.02).

CONCLUSION

In GIB of any origin, extravasated contrast volumetric analysis at CTA could be a predictor of positive angiography and may help in avoiding further unnecessary procedures.

摘要

背景

胃肠道出血（GIB）是一种严重且可能危及生命的病症，尤其是在治疗延迟的情况下。计算机断层血管造影（CTA）在上下消化道出血的早期识别以及出血的及时治疗中起着关键作用。

目的

确定在胃肠道出血的CTA检查中，外渗造影剂的容积估计是否可作为后续血管造影阳性结果的预测指标。

方法

在这项回顾性单中心研究中，纳入了2018年1月至2022年2月期间因CTA检测到活动性胃肠道出血而入住我院并进一步接受导管血管造影的35例患者（22例男性；中位年龄69岁；范围16 - 92岁）。23例（65.7%）患者在CTA检查前接受了内镜检查。使用半自动专用软件在动脉期和静脉期评估出血容积。通过两个阶段之间的容积变化获得出血速率，并按单位时间进行标准化。根据血管造影征象及其与CTA的一致性将患者分为两组。

结果

上消化道出血占42.9%，下消化道出血占57.1%。入院时平均血红蛋白值为7.7 g/dL。19例（54.3%）病例中CTA阳性与直接血管造影出血征象之间存在一致性。尽管动脉期出血量无显著差异（0.55 mL ± 0.33 mL，P = 0.35），但血管造影阳性的患者组在静脉期出血量有统计学意义的增加（2.06 mL ± 0.9 mL，P = 0.02）。在后者患者组中，出血速率也有显著增加（2.18 mL/min ± 0.19 mL/min，P = 0.02）。