Jiang Yuchen, Li Yuanqiu, Xiong Ziman, Morelli John N, Shen Yaqi, Hu Xuemei, Hu Daoyu, Li Zhen
Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Radiology, St. John's Medical Center, Tulsa, OK, USA.
Insights Imaging. 2024 Aug 1;15(1):189. doi: 10.1186/s13244-024-01778-6.
The purpose of this study is to assess the diagnostic efficacy of contrast-enhanced CT scans for small bowel bleeding.
This retrospective study evaluated patients diagnosed with non-neoplastic small intestinal bleeding (including duodenum) who underwent abdominal CT at our institution from December 2013 to March 2023. Patients were categorized into diverticulum and non-diverticulum groups based on the cause of bleeding. Active bleeding was defined on the CT images as extravasation of contrast material in the intestinal lumen during the arterial phase and/or progressive accumulation of contrast material during the venous phase. We have documented the original report (extracted from the medical record system and additional consultation opinions from senior radiologists), including the presence of active bleeding and its potential bleeding location. Furthermore, two radiologists reassessed the CT images, seeking consensus on the diagnosis between them.
The study included 165 patients, predominantly male, with a median age of 30 years. Active bleeding was identified in 48.3% of patients. Notably, all identified bleeding diverticula in the diverticulum group exhibited cul-de-sac termination. Among the identified causes of bleeding, Crohn's disease was most prevalent (46.7%, N of causes = 64). Significant differences were observed in the diagnostic methods between the diverticulum and non-diverticulum groups, with surgery predominantly applied in the diverticulum group, and endoscopy in the non-diverticulum group (n = 49 vs n = 15, p = 0.001). Contrast agent extravasation was significantly higher in the diverticulum group (n = 54 vs n = 16, p = 0.001), and Meckel's diverticulum cases appearing tubular were significantly higher than in other diverticulum cases (n = 25 vs n = 3, p < 0.001).
CT allows for a higher detection rate of diverticular bleeding, even if asymptomatic, guiding classification into multiple potentially clinically relevant categories.
Contrast-enhanced CT imaging is effective in determining the location and cause of non-neoplastic small bowel bleeding, especially diverticular bleeding. Therefore, the use of enhanced CT should be prioritized in the diagnosis and management of small bowel bleeding.
CT has potential value in the diagnosis of small bowel bleeding. CT imaging suggests possible surgical intervention for active bleeding detection. CT diagnoses and localizes small bowel bleeding, aiding in treatment and prioritizing in guidelines.
本研究旨在评估对比增强CT扫描对小肠出血的诊断效能。
这项回顾性研究评估了2013年12月至2023年3月在我院接受腹部CT检查、被诊断为非肿瘤性小肠出血（包括十二指肠）的患者。根据出血原因将患者分为憩室组和非憩室组。CT图像上，活动性出血定义为动脉期肠腔内造影剂外渗和/或静脉期造影剂逐渐积聚。我们记录了原始报告（从病历系统中提取以及资深放射科医生的额外会诊意见），包括是否存在活动性出血及其潜在出血部位。此外，两名放射科医生重新评估了CT图像，力求在诊断上达成共识。
该研究纳入了165例患者，以男性为主，中位年龄为30岁。48.3%的患者被发现有活动性出血。值得注意的是，憩室组中所有已发现的出血性憩室均表现为盲端终止。在已确定的出血原因中，克罗恩病最为常见（46.7%，病因数量N = 64）。憩室组和非憩室组的诊断方法存在显著差异，憩室组主要采用手术治疗，非憩室组主要采用内镜检查（n = 49对n = 15，p = 0.001）。憩室组的造影剂外渗明显更高（n = 54对n = 16，p = 0.001），呈管状的梅克尔憩室病例明显高于其他憩室病例（n = 25对n = 3，p < 0.001）。
CT对憩室出血的检出率更高，即使是无症状的，有助于将其分类为多个潜在的临床相关类别。
对比增强CT成像在确定非肿瘤性小肠出血的部位和原因方面有效，尤其是憩室出血。因此，在小肠出血的诊断和管理中应优先使用增强CT。
CT在小肠出血诊断中具有潜在价值。CT成像提示对活动性出血检测可能需要手术干预。CT可诊断并定位小肠出血，有助于治疗并在指南中确定优先顺序。
