Diagnostic accuracy of RBC scintigraphy and CTA for detection of patients with suspected lower gastrointestinal bleeding: a systematic review and meta-analysis.
Journal
Nuclear medicine communications
ISSN: 1473-5628
Titre abrégé: Nucl Med Commun
Pays: England
ID NLM: 8201017
Informations de publication
Date de publication:
01 Dec 2023
01 Dec 2023
Historique:
medline:
9
11
2023
pubmed:
2
10
2023
entrez:
2
10
2023
Statut:
ppublish
Résumé
Detection of lower gastrointestinal bleeding (LGIB) through noninvasive modalities is very important in the successful management of LGIB. RBC scintigraphy and CT have a role in the detection of LGIB and guiding the management of patient by localization of the bleeding site. However, only a small number of studies have evaluated the role of RBC scintigraphy and CT in the diagnosis of LGIB. This systematic review was conducted to evaluate the diagnostic performance of RBC scintigraphy and CT in the detection of LGIB in patients with clinical or biochemical findings suspicious of LGIB. This systematic review followed PRISMA guidelines. Searches in PubMed, Scopus, and Embase were conducted using relevant keywords, and articles published through 30 April 2022, were included. Using endoscopy or surgical outcomes as the reference standard, the numbers of true and false positives and true and false negatives were extracted. Pooled estimates of diagnostic test accuracy - including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and summary ROC (SROC) curve - were generated using bivariate random-effects meta-analysis. Three studies comprising 171 patients were included in the systematic review and meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for the detection of LGIB using RBC scintigraphy were 0.787 (95% CI, 0.643-0.893), 0.289 (95% CI, 0.164-0.443), 1.214 (95% CI, 0.923-1.597) and 0.576 (95% CI, 0.296-1.121) respectively. The area under the SROC curve was 0.73. The pooled sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio for the detection of LGIB using CT were 0.931 (95% CI, 0.772-0.992), 0.870 (95% CI, 0.737-0.951), 6.085 (95% CI, 0.840-44.097), 0.126 (95% CI, 0.006-2.509) respectively. The area under the SROC curve was 0.095. RBC scintigraphy has overall good sensitivity and CTA has excellent sensitivity specificity, positive and negative likelihood ratio in the detection of LGIB in patients with clinical or biochemical findings suspicious for LGIB.CTA along with RBC scintigraphy can be used algorithmically to rule out patients who do not have a localization for the site of LGIB thereby helping these patients to avoid invasive procedures like endoscopy or surgical explorations.
Identifiants
pubmed: 37779432
doi: 10.1097/MNM.0000000000001759
pii: 00006231-990000000-00219
doi:
Types de publication
Meta-Analysis
Systematic Review
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1074-1079Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Références
Jairath V, Hearnshaw S, Brunskill SJ, Doree C, Hopewell S, Hyde C, et al. Red cell transfusion for the management of upper gastrointestinal haemorrhage. Cochrane Database Syst Rev 2010; 9:CD006613.
Navuluri R, Kang L, Patel J, Van Ha T. Acute lower gastrointestinal bleeding. Semin Intervent Radiol 2012; 29:178–186.
Dam HQ, Brandon DC, Graham VV, Hilson AJ, Howarth DM, Maurer AH, et al. The SNMMI procedure standard/ EANM practice guideline for gastrointestinal bleeding scintigraphy 2.0. J Nucl Med Technol 2014; 42:308–317.
Kim BSM, Li BT, Engel A, Samra JS, Clarke S, Norton ID, et al. Diagnosis of gastrointestinal bleeding: a practical guide for clinicians. World J Gastrointest Pathophysiol 2014; 5:467–478.
Dusold R, Burke K, Carpentier W, Dyck WP. The accuracy of technetium-99m-labeled red cell scintigraphy in localizing gastrointestinal bleeding. Am J Gastroenterol 1994; 89:345–348.
Scheffel H, Pfammatter T, Wildi S, Bauerfeind P, Marincek B, Alkadhi H. Acute gastrointestinal bleeding: detection of source and etiology with multi-detector-row CT. Eur Radiol 2007; 17:1555–1565.
Lee C, Jang JK, Shin JH, Song S, Kang B. Role of computed tomography angiography for acute gastrointestinal bleeding. Int J Gastrointest Interv 2018;7:106–111.
Ernst O, Bulois P, Saint-Drenant S, Leroy C, Paris J-C, Sergent G. Helical CT in acute lower gastrointestinal bleeding. Eur Radiol 2003; 13:114–117.
Tew K, Davies RP, Jadun CK, Kew J. MDCT of acute lower gastrointestinal bleeding. AJR Am J Roentgenol 2004; 182:427–430.
Kuhle WG, Sheiman RG. Detection of active colonic hemorrhage with use of helical CT: findings in a swine model. Radiology 2003; 228:743–752.
Yoon W, Jeong YY, Shin SS, Lim HS, Song SG, Jang NG, et al. Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi-detector row helical CT. Radiology 2006; 239:160–167.
Whiting PF, Rutjes AW, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, et al.; QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 2011; 155:529–536.
Arends LR, Hamza TH, van Houwelingen JC, Heijenbrok-Kal MH, Hunink MG, Stijnen T. Bivariate random effects meta-analysis of ROC curves. Med Decis Making 2008; 28:621–638.
Harbord RM, Whiting P, Sterne JA, Egger M, Deeks JJ, Shang A, et al. An empirical comparison of methods for meta-analysis of diagnostic accuracy showed hierarchical models are necessary. J Clin Epidemiol 2008; 61:1095–1103.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003; 327:557–560.
Awais M, Haq TU, Rehman A, Zaman MU, Haider Z, Khattak YJ, et al. Accuracy of 99mTechnetium-labeled RBC scintigraphy and MDCT with gastrointestinal bleed protocol for detection and localization of source of acute lower gastrointestinal bleeding. J Clin Gastroenterol 2016; 50:754–760.
Diehl SJ, Ko HS, Dominguez E, Kaare Tesdal I, Kähler G, Böhm C, et al. Negative endoskopie sowie Mehrzeilendetektor-CT bei Patienten mit akuter unterer Gastrointestinalblutun. Wertigkeit der Szintigraphie mit (99m)Tc-markierten Erythrozyten [Negative endoscopy and MSCT findings in patients with acute lower gastrointestinal hemorrhage. Value of (99m)Tc erythrocyte scintigraphy]. Radiologe 2007; 47:64–70.
Zink SI, Ohki SK, Stein B, Zambuto DA, Rosenberg RJ, Choi JJ, et al. Noninvasive evaluation of active lower gastrointestinal bleeding: comparison between contrast-enhanced MDCT and 99mTc-labeled RBC scintigraphy. AJR Am J Roentgenol 2008; 191:1107–1114.
Bunker SR, Lull RJ, Tanasescu DE, Redwine MD, Rigby J, Brown JM, et al. Scintigraphy of gastrointestinal hemorrhage: superiority of 99mTc red blood cells over 99mTc sulfur colloid. AJR Am J Roentgenol 1984.
Wu LM, Xu JR, Yin Y, Qu XH. Usefulness of CT angiography in diagnosing acute gastrointestinal bleeding: a meta-analysis. World J Gastroenterol 2010; 16:3957–3963.
García-Blázquez V, Vicente-Bártulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J; EBM-Connect Collaboration. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol 2013; 23:1181–1190.