Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 7, 2015; 21(13): 4030-4037
Published online Apr 7, 2015. doi: 10.3748/wjg.v21.i13.4030
Lower gastrointestinal bleeding: Role of 64-row computed tomographic angiography in diagnosis and therapeutic planning
Jian-Zhuang Ren, Meng-Fan Zhang, Ai-Mei Rong, Xiang-Jie Fang, Kai Zhang, Guo-Hao Huang, Peng-Fei Chen, Zhao-Yang Wang, Xu-Hua Duan, Xin-Wei Han, Yan-Jie Liu
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
Ai-Mei Rong, Xiang-Jie Fang, Yan-Jie Liu, Department of General Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
Author contributions: Ren JZ, Zhang MF, Rong AM, Fang XJ, Zhang K, Chen PF and Liu YJ performed the majority of experiments; Huang GH, Wang ZY and Duan XH provided vital reagents and analytical tools and were also involved in revising the manuscript; Han XW collected all the human materials and provided financial support for this work; and Ren JZ designed the study and wrote the manuscript.
Ethics approval: The study was reviewed and approved by the First Affiliated Hospital of Zhengzhou University Institutional Review Board.
Clinical trial registration: We declare that we have no clinical trial registration for this study.
Informed consent: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest: We declare that we have no conflict of interest in this study.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at rjzjrk@126.com. Participants gave informed consent for data sharing. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jian-Zhuang Ren, Professor, Department of Interventional Radiology, the First Affiliated Hospital of Zhengzhou University, No. 1, East Jian She Road, Zhengzhou 450052, Henan Province, China. rjzjrk@126.com
Telephone: +86-371-66862162 Fax: +86-371-66862162
Received: September 3, 2014
Peer-review started: September 4, 2014
First decision: October 29, 2014
Revised: November 26, 2014
Accepted: January 16, 2015
Article in press: January 16, 2015
Published online: April 7, 2015
Processing time: 215 Days and 19 Hours
Abstract

AIM: To determine the value of computed tomographic angiography (CTA) for diagnosis and therapeutic planning in lower gastrointestinal (GI) bleeding.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Keywords: Gastrointestinal bleeding; Digital subtraction angiography; Surgical resection; Computed tomography angiography; Embolization

Core tip: The best modality for the initial diagnosis of acute lower gastrointestinal bleeding (GI) bleeding is controversial. We determined the clinical value of computed tomography angiography (CTA) for diagnosis and therapeutic planning in patients with lower GI bleeding. Sixty-three consecutive patients with acute lower GI bleeding underwent CTA before endovascular or surgical treatment. We found a high overall location-based accuracy, sensitivity, and specificity for the diagnosis and therapeutic planning of acute GI bleeding. We suggest that 64-row CTA is safe and effective in diagnosis and therapeutic planning, without performing digital subtraction angiography or surgery, in patients with lower GI bleeding.