PURPOSE: Technicium 99m (99m Tc) labelled scan is often done to localize bleeding to facilitate treatment. No level 1 or 2 data supports this approach. The aim of this study was to determine the correlation between site of bleeding by nuclear scan and findings at surgery, angiogram or colonoscopy.
METHODS: Medical Records of all patients admitted to Cooper University Hospital from January 2001-December2005 with LGIB who had 99mTc scan were analyzed.
RESULTS: 164 of 170 patients were eligible to be evaluated. 6 patients were excluded due to incomplete medical records. There were 45 positive (27.5%) and 119 negative scans (72.5%). 21 of the 45 patients with positive scans had angiography. 7 patients (33.3%) had positive (+) and 14 (66.6%) negative (-) angiograms. In 6 patients (85.7%) with (+) angiograms, there was correlation on the area of bleed as seen on the 99mTc scan (p=0.125). 20 patients in the positive scan group required surgery. In 15 (75%)the findings at surgery correlated with the scan result (p=0.04). 31 patients (68.8%) with positive scan had colonoscopy. There was correlation in 27 patients (87.0%) (p<0.001). The patients with(+) scan received a total of 372(8.2 per patient) transfusions of packed red blood cells (PRBC) compared to 333 (2.7 per patients) transfusions in patients with (-) scans. Surgeons documented in 7 patients that the result of scan influenced surgery. Patients with (+) and (-) scans had similar rates of colonoscopy (73.35 vs 76.4%),Hospital length of stay (14.3 vs 12.10 days), while mortality rate was (8.8% vs 6.72%)respectively.
CONCLUSION: 99mTc scan has low yield in the evaluation of LGIB. However when positive, they tend to correlate with findings at angiogram, surgery and colonoscopy.
CLINICAL IMPLICATIONS: 99m Tc has a low sensitivity for detecting LGIB. Rate of bleeding imparts on the result. Patients with higher rate of bleeding are unstable and the risk of taking them to the radiology suite outweighs the benefits. Despite these limitations, a positive result is helpful in planning definitive treatment.
DISCLOSURE: Kizito Ojiako, No Financial Disclosure Information; No Product/Research Disclosure Information