Ettorre G C, Francioso G, Garribba A P, Fracella M R, Greco A, Farchi G
Istituto di Radiologia.
Radiol Med. 1995 Dec;90(6):726-33.
Some 5-20% of gastrointestinal (GI) bleeding cases are of obscure origin because bleeding is difficult to diagnose or locate with conventional imaging methods. The authors suggest arterial spiral CT (ASCT) of the abdomen as an original tool to study GI bleeding of obscure origin. This diagnostic method consists of two subsequent phases: first, after abdominal aorta catheterization, the catheter is positioned in the celiac artery; then, CT of the abdomen is performed before and after intra-arterial contrast agent injection. In 6 of 10 patients with GI bleeding of obscure origin, ASCT depicted small high-intensity areas in the intestinal lumen, which indicate a source of bleeding. The site of bleeding was studied only with topographic criteria according to scanning planes, and the morphological features of the intestinal segments were investigated. All patients were submitted to surgery: when ASCT identified a bleeding site, angiography was limited to the involved arterial district. Angiography alone could locate the source of bleeding in 5 patients; angiography and ASCT were in agreement in 4 patients. The combined techniques located the source of bleeding in 7/10 patients and the nature of bleeding was diagnosed in 3/10 patients (angiodysplasia). Even though their experience is limited, the authors believe that ASCT can be useful in locating GI bleeding of obscure origin, as well as in guiding subsequent selective angiography.
约5%-20%的胃肠道（GI）出血病例病因不明，因为使用传统成像方法难以诊断或定位出血部位。作者建议将腹部动脉螺旋CT（ASCT）作为研究不明原因GI出血的一种原始工具。这种诊断方法包括两个连续阶段：首先，在腹主动脉插管后，将导管置于腹腔动脉；然后，在动脉内注射造影剂前后进行腹部CT检查。在10例不明原因GI出血患者中，有6例ASCT显示肠腔内有小的高密度区，提示出血部位。仅根据扫描平面的地形学标准研究出血部位，并研究肠段的形态学特征。所有患者均接受手术：当ASCT确定出血部位时，血管造影仅限于受累动脉区域。单纯血管造影能在5例患者中定位出血部位；血管造影和ASCT在4例患者中结果一致。联合技术在7/10的患者中定位了出血部位，在3/10的患者中诊断出出血性质（血管发育异常）。尽管作者的经验有限，但他们认为ASCT有助于定位不明原因的GI出血，并指导后续的选择性血管造影。
