背景:胃肠道出血(GIB)是一种严重且可能危及生命的疾病,特别是在延迟治疗的情况下。计算机断层扫描血管造影(CTA)在早期识别上,下GIB和及时治疗出血中起着关键作用。
目的:确定GIB中CTA外渗造影剂的体积估计是否可以预测随后的血管造影阳性结果。
方法:在这项回顾性单中心研究中,纳入了在2018年1月至2022年2月期间因CTA检测到活动性GIB而入院的35例患者(22例男性;中位年龄69岁;范围16-92岁),并进一步接受导管血管造影。23例(65.7%)患者在CTA之前接受了内窥镜检查。通过半自动专用软件在动脉和静脉阶段评估出血容量。从两个阶段之间的体积变化获得出血率,并在单位时间内标准化。患者分为两组,根据血管造影征象及其与CTA的一致性。
结果:上出血占42.9%,下出血占57.1%。入院时的平均血红蛋白值为7.7g/dL。在19例(54.3%)中发现CTA阳性与直接血管造影出血体征之间存在一致性。尽管动脉期的出血量没有显着差异(0.55mLvs0.33mL,P=0.35),在血管造影阳性的患者组中,静脉期有统计学意义的体积增加(2.06mLvs0.9mL,P=0.02)。在后一个患者组中,出血率显着增加(2.18mL/minvs0.19mL/min,P=0.02)。
结论:在任何来源的GIB中,CTA的外渗造影剂体积分析可能是血管造影阳性的预测指标,并可能有助于避免进一步不必要的手术。
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.
OBJECTIVE: 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 via 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 vs 0.33 mL, P = 0.35), a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography (2.06 mL vs 0.9 mL, P = 0.02). In the latter patient group, a significant increase in bleeding rate was also detected (2.18 mL/min vs 0.19 mL/min, P = 0.02).
CONCLUSIONS: 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.