| Predictive value of technetium Tc 99m-labeled red blood cell scintigraphy for positive angiogram in massive lower gastrointestinal hemorrhage. | |
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MedLine Citation:
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PMID: 9106699 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: This study was performed to evaluate whether the time interval from injection of technetium Tc 99m (99mTc)-labeled red blood cells to the time of a radionuclide "blush" (positive scan) can be used to improve the efficacy in predicting a positive angiogram. METHOD: A retrospective review revealed 160 patients who received 99mTc-labeled red blood cell scintigraphy for evaluation of massive lower gastrointestinal hemorrhage between 1989 and 1994. Patients were included who demonstrated signs of shock on admission, had an initial decrease in hematocrit of > or = 6 percent, or required a minimum transfusion of two units of packed red blood cells. Scanning duration was 90 minutes, with imaging every 2 minutes. Time interval from injection to a positive scan was analyzed to determine predictability of a positive angiography. RESULTS: Of 160 patients, 86 demonstrated positive scans, of whom 47 underwent angiography. These 47 patients were divided into two groups according to scan results. Group 1 (n = 33) had immediate appearance of blush; Group 2 (n = 14) had blush after two minutes. In Group 1, 20 of 33 patients had a positive angiogram, yielding a positive predictive value of 60 percent (P = 0.033). Of the 14 patients with negative angiograms (13 from Group 1, and 1 with a negative scan), 6 had radiographic occlusion of the inferior mesenteric artery and 1 had spasm of the right colic artery, with scans that blushed in the respective distributions. Excluding these seven patients yielded a positive predictive value of 75 percent (P = 0.0072) for angiography. In patients with a delayed blush (Group 2), 13 of 14 had negative angiograms, yielding a negative predictive value of 93 percent (92 percent excluding those with nonvisualization of the inferior mesenteric artery). Twenty of 21 (95 percent) positive angiograms occurred in Group 1 patients. Of the 27 patients with negative angiograms, 13 were Group 2 patients. CONCLUSION: Patients with immediate blush on 99mTc-labeled red blood cell scintigraphy required urgent angiography. Patients with delayed blush have low angiographic yields. These data suggest that patients with delayed blush or negative scans may be observed and evaluated with colonoscopy. |
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Authors:
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D A Ng; F G Opelka; D E Beck; J M Milburn; L R Witherspoon; T C Hicks; A E Timmcke; J B Gathright |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Diseases of the colon and rectum Volume: 40 ISSN: 0012-3706 ISO Abbreviation: Dis. Colon Rectum Publication Date: 1997 Apr |
Date Detail:
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Created Date: 1997-05-01 Completed Date: 1997-05-01 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0372764 Medline TA: Dis Colon Rectum Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 471-7 Citation Subset: IM |
Affiliation:
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Department of Colon and Rectal Surgery, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, Louisiana 70121, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Algorithms Angiography Colonic Diseases / radionuclide imaging* Colonoscopy Erythrocytes* Female Gastrointestinal Hemorrhage / radionuclide imaging* Humans Male Middle Aged Radiopharmaceuticals / diagnostic use* Reproducibility of Results Retrospective Studies Sensitivity and Specificity Sodium Pertechnetate Tc 99m / diagnostic use* Time Factors |
| Chemical | |
Reg. No./Substance:
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0/Radiopharmaceuticals; 23288-60-0/Sodium Pertechnetate Tc 99m |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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