Moritz Wildgruber1, Christian E Wrede2, Niels Zorger3, René Müller-Wille4, Okka W Hamer4, Florian Zeman5, Christian Stroszczynski4, Peter Heiss4. 1. Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, D-93053 Regensburg, Germany; Institut für klinische Radiologie, Universitätsklinikum Münster, D-48149 Münster, Germany. Electronic address: moritzwildgruber@ukmuenster.de. 2. Notfallzentrum, Helios Klinikum Berlin-Buch, D-13125 Berlin, Germany. 3. Institut für Radiologie, Neuroradiologie und Nuklearmedizin, Krankenhaus Barmherzige Brüder, D-93049 Regensburg, Germany. 4. Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, D-93053 Regensburg, Germany. 5. Zentrum für Klinische Studien, Universitätsklinikum Regensburg, D-93053 Regensburg, Germany.
Abstract
PURPOSE: The diagnostic yield of computed tomography angiography (CTA) compared to digital subtraction angiography (DSA) for major obscure gastrointestinal bleeding (OGIB) is not known. Aim of the study was to prospectively evaluate the diagnostic yield of CTA versus DSA for the diagnosis of major OGIB. MATERIAL AND METHODS: The institutional review board approved the study and informed consent was obtained from each patient. Patients with major OGIB were prospectively enrolled to undergo both CTA and DSA. Two blinded radiologists each reviewed the CTA and DSA images retrospectively and independently. Contrast material extravasation into the gastrointestinal lumen was considered diagnostic for active bleeding. Primary end point of the study was the diagnostic yield, defined as the frequency a technique identified an active bleeding or a potential bleeding lesion. The diagnostic yield of CTA and DSA were compared by McNemar's test. RESULTS: 24 consecutive patients (11 men; median age 64 years) were included. CTA and DSA identified an active bleeding or a potential bleeding lesion in 92% (22 of 24 patients; 95% CI 72%-99%) and 29% (7 of 24 patients; 95% CI 12%-49%) of patients, respectively (p<0.001). CTA and DSA identified an active bleeding in 42% (10 of 24; 95% CI 22%-63%) and 21% (5 of 24; 95% CI 7%-42%) of patients, respectively (p=0.06). CONCLUSION: Due to the lower invasiveness and higher diagnostic yield CTA should be favored over DSA for the diagnosis of major OGIB.
PURPOSE: The diagnostic yield of computed tomography angiography (CTA) compared to digital subtraction angiography (DSA) for major obscure gastrointestinal bleeding (OGIB) is not known. Aim of the study was to prospectively evaluate the diagnostic yield of CTA versus DSA for the diagnosis of major OGIB. MATERIAL AND METHODS: The institutional review board approved the study and informed consent was obtained from each patient. Patients with major OGIB were prospectively enrolled to undergo both CTA and DSA. Two blinded radiologists each reviewed the CTA and DSA images retrospectively and independently. Contrast material extravasation into the gastrointestinal lumen was considered diagnostic for active bleeding. Primary end point of the study was the diagnostic yield, defined as the frequency a technique identified an active bleeding or a potential bleeding lesion. The diagnostic yield of CTA and DSA were compared by McNemar's test. RESULTS: 24 consecutive patients (11 men; median age 64 years) were included. CTA and DSA identified an active bleeding or a potential bleeding lesion in 92% (22 of 24 patients; 95% CI 72%-99%) and 29% (7 of 24 patients; 95% CI 12%-49%) of patients, respectively (p<0.001). CTA and DSA identified an active bleeding in 42% (10 of 24; 95% CI 22%-63%) and 21% (5 of 24; 95% CI 7%-42%) of patients, respectively (p=0.06). CONCLUSION: Due to the lower invasiveness and higher diagnostic yield CTA should be favored over DSA for the diagnosis of major OGIB.