technetium-tc-99m-sulfur-colloid and Gastrointestinal-Hemorrhage

The clinical consequences of lower gastrointestinal bleeding range from trivial to life-threatening. Nuclear medicine imaging techniques allow identification of those patients who are actively bleeding. The demonstration of active bleeding not only provides important prognostic information but also allows for a coordinated imaging approach using angiography and aids localization of the bleeding site. (99m)Tc-labeled erythrocytes and (99m)Tc sulfur colloid are 2 commonly used techniques to detect active bleeding. Each has its respective advantages and disadvantages, but the medical literature indicates that both tests are useful. More prolonged or delayed imaging is possible using (99m)Tc-labeled erythrocytes but care is required to prevent misinterpretation of the bleeding location because of a higher likelihood of radiotracer movement through the bowel away from the bleeding site. These forms of scintigraphy may be helpful in risk-stratifying patients and planning radiological and surgical interventions. Careful selection of patients to include those who have a high likelihood of active bleeding greatly increases the clinical utility of these tests. In addition, (99m)Tc pertechnetate imaging may be diagnostic of ectopic gastric mucosa in a Meckel's diverticulum as a potential source of bleeding. Patients also should be carefully selected for this test, based on age and exclusion of other causes of bleeding.

Topics: Acute Disease; Erythrocytes; Gastrointestinal Hemorrhage; Gastrointestinal Tract; Humans; Meckel Diverticulum; Radionuclide Imaging; Radiopharmaceuticals; Technetium; Technetium Tc 99m Sulfur Colloid

Radionuclide bleeding scintigraphy remains a simple yet powerful method of localizing sites of gastrointestinal hemorrhage and is most commonly performed today using the red blood cell technique. Radionuclide techniques for detecting bleeding remain safe, sensitive, and noninvasive. Based on several simple concepts, including the use of cine-mode imaging over the abdomen, it is possible to achieve excellent accuracy in localizing the site of bleeding. Studies often contain additional ancillary information, which is helpful for diagnosis and patient treatment.

Topics: Acute Disease; Adult; Aged; Aged, 80 and over; Diagnosis, Differential; Erythrocytes; Female; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Gastrointestinal Tract; Humans; Infant; Male; Practice Guidelines as Topic; Practice Patterns, Physicians'; Radionuclide Imaging; Radiopharmaceuticals; Technetium Compounds; Technetium Tc 99m Sulfur Colloid

Radionuclide studies today can specify the actual state of gastrointestinal bleeding. "Radionuclide monitoring" characterises a method that allows a long-term surveillance of the patient for hours or even days (sequential scintigraphy). Labelling of the intravasal space is best met by in vivo/vitro labelling of the red blood cells with 99mTc, "Radionuclide monitoring" may positively influence current concepts of diagnosis or treatment control of patients suffering from gastrointestinal bleeding.

Topics: Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Middle Aged; Monitoring, Physiologic; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

Gastrointestinal bleeding is a common and occasionally life-threatening problem in infants and children. A careful history and physical examination as well as the application of new endoscopic and radiographic techniques will reveal the source of hemorrhage in most patients. The utility of recently introduced pharmacologic agents and endoscopic techniques in the treatment of peptic disease and variceal hemorrhage in children remains to be determined. A cooperative effort among pediatricians, radiologists, and surgeons should minimize the morbidity and mortality from gastrointestinal tract bleeding in this population.

Topics: Angiography; Antacids; Barium Sulfate; Child; Colonoscopy; Digestive System; Endoscopy; Enema; Esophageal and Gastric Varices; Gastric Lavage; Gastrointestinal Hemorrhage; Hemostatic Techniques; Histamine H2 Antagonists; Humans; Infant; Infant, Newborn; Peptic Ulcer Hemorrhage; Radionuclide Imaging; Sigmoidoscopy; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid

Angiography has become an integral tool in the management of patients with gastrointestinal bleeding. It is used for localizing the site of bleeding and then for controlling the bleeding when more conservative methods of treatment are unsuccessful.

Topics: Angiography; Blood Vessels; Endoscopy; Erythrocytes; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Hemostatic Techniques; Humans; Intestine, Small; Mesenteric Veins; Peptic Ulcer Hemorrhage; Postoperative Complications; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Varicose Veins; Vasopressins

Topics: Adult; Cholestasis, Extrahepatic; Cystic Duct; Esophagus; Female; Gallbladder; Gastric Emptying; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Imino Acids; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Lidofenin; Technetium Tc 99m Sulfur Colloid

The objective of the study was to determine if time to positive (TTP), defined as the time from the start of (99m)Tc-labeled RBC scanning to the appearance of a radionuclide blush (considered to be a positive finding for acute lower gastrointestinal bleeding [LGIB]), and lag time (LT), defined as the time from the appearance of a radionuclide blush to the start of catheter angiography (CA), affected the yield of CA for the detection of acute LGIB.. TTP and LT were retrospectively evaluated in 120 patients who had positive findings for acute LGIB on (99m)Tc-labeled RBC scanning and subsequently underwent CA for the diagnosis and localization of gastrointestinal bleeding. Two nuclear medicine fellowship-trained radiologists independently reviewed the (99m)Tc-labeled RBC scans. Two fellowship-trained interventional radiologists independently reviewed the angiograms. All data were analyzed using SAS software.. When a TTP threshold of ≤ 9 minutes was used, the sensitivity, specificity, positive predictive value, and negative predictive value for a positive CA study were 92%, 35%, 27%, and 94%, respectively. In addition, the odds of detecting bleeding on CA increased 6.1-fold with a TTP of ≤ 9 minutes relative to a TTP of > 9 minutes (p = 0.020). A significant inverse relationship was found between LT and a positive CA study (p = 0.041).. TTP and LT impact the rate of positive CA studies. A TTP threshold of ≤ 9 minutes allows the detection of almost all patients who would benefit from CA for treatment and allows a reduction in unnecessary negative CA studies. The likelihood of positive findings on CA decreases with a delay in the performance of CA.

Topics: Acute Disease; Aged; Aged, 80 and over; Angiography; Gastrointestinal Hemorrhage; Humans; Middle Aged; Predictive Value of Tests; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Technetium Tc 99m Sulfur Colloid; Time Factors

Lower gastrointestinal bleeding is a common cause of hospital admission. This bleeding is most often secondary to diverticuli, malignancy, or colitis. Rarely, the location of lower gastrointestinal bleeding cannot be identified after exhaustive efforts with endoscopy, angiography, and other modalities. To address this unique clinical situation, we present a modification of the technique for sentinel lymph node biopsy in which a gamma probe is used to identify the source of hemorrhage. This is completed intraoperatively after preoperative radioactive technetium sulfur colloid is injected at the time of angiography. This approach involves minimal risk and provides the surgeon with an improved ability to localize bleeding, as well as potentially minimize the extent of bowel resection.

Topics: Angiography; Female; Gamma Cameras; Gastrointestinal Hemorrhage; Humans; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Sentinel Lymph Node Biopsy; Technetium Tc 99m Sulfur Colloid

Topics: Abdomen; Adult; Diagnosis, Differential; Gastrointestinal Hemorrhage; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Splenosis; Technetium Tc 99m Sulfur Colloid

A 41-year-old woman with rectal bleeding was referred to our department for gastrointestinal (GI) bleeding study. She was in early post-menstrual period and had stable vital signs. A GI bleeding study with Tc-99m SC revealed uterine blush in the pelvis. The shape of activity and quick fading excluded a GI bleeding. To rule out an intermittent bleeding, patient underwent a second bleeding study with Tc-99m RBC. Serial images showed uterine "doughnut" in the pelvis. The activity neither changed in shape nor showed distal movement with time excluding a GI hemorrhage. Uterus in early proliferating phase could be a potential pitfall in GI bleeding studies.

Topics: Diagnosis, Differential; Diagnostic Errors; Erythrocytes; Female; Follicular Phase; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Radiopharmaceuticals; Technetium Compounds; Technetium Tc 99m Sulfur Colloid; Uterus

Major breakthroughs in catheter, guidewire, and other angiographic equipment currently allow interventional radiologists to diagnose massive life-threatening upper and lower GI hemorrhage and to stop the bleeding safely and effectively using superselective catheterization and microcoil embolization. Similarly, the interventional radiologist can treat acute intestinal ischemia safely and effectively with selective catheterization and papaverine administration and treat chronic mesenteric ischemia by percutaneous angioplasty and stent placement. A multidisciplinary approach, including the gastroenterologist, radiologist, and surgeon, is critical in managing GI bleeding and intestinal ischemia, particularly in patients at high risk or presenting as diagnostic dilemmas.

Topics: Diverticulitis, Colonic; Embolization, Therapeutic; Gastrointestinal Hemorrhage; Humans; Intestine, Small; Ischemia; Mesentery; Radiography; Radionuclide Angiography; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

The objective of this study was to determine whether the Tc-99m red blood cells (Tc-99m RBC) method has a true advantage over the Tc-99m sulfur colloid (Tc-99m SC) technique in a busy clinical practice for detecting and localizing lower gastrointestinal bleeding sites.. Three hundred fifty-nine consecutive gastrointestinal bleeding studies performed during the past 4 years were reviewed retrospectively. One hundred ninety-three scans were obtained with Tc-99m SC (scan duration, 30 minutes) and 138 studies were performed after the administration of Tc-99m RBC (scan duration, 1 hour). In addition, 28 examinations with Tc-99m SC were followed immediately by Tc-99m RBC scans for a duration of several hours. The results of the two methods were analyzed and the performance of the two techniques was compared.. Among 193 scans performed using the Tc-99m SC method, 47 (24.4%) successfully identified the location of the bleeding site, whereas in 138 scans performed using Tc-99m RBC, 38 (27.5%) were successful for this purpose. In the remaining 28 scans in which the Tc-99m SC scan was followed by the Tc-99m RBC study, only 4 (14.3%) positive bleeding sites were identified after a prolonged imaging period.. The theoretical advantages of the Tc-99m RBC technique compared with the Tc-99m SC method cannot be substantiated by this study. Our findings suggest that the efficacy of these two methods is nearly equal at a practical level.. The simpler and cost-effective Tc-99m SC method is as efficient as the Tc-99m RBC method when the scanning time is limited to 1 hour and optimal imaging and interpretation schemes are used.

Topics: Adult; Aged; Aged, 80 and over; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid; Time Factors

Two recent advances have significantly improved the ability of labeled red cell imaging to localize and to detect sites of active gastrointestinal bleeding. The first is the use of continuous dynamic imaging. The second is the commercial availability of an in vitro red cell labeling method that significantly improves image quality. The computer equipment required for dynamic imaging is available in most nuclear medicine laboratories. Because cinematic display of the dynamic images increases the accuracy and ease of interpretation it should be considered the method of choice for performing gastrointestinal bleeding studies. High-risk patients can be identified if very active bleeding is noted early. However, a study with negative results, after monitoring the patient over 1 to 2 hours, suggests that conservative medical management may be adequate. Therefore, with proper use scintigraphy can provide both diagnostic and prognostic information to aid in the management of patients with gastrointestinal bleeding.

Topics: Erythrocytes; Gastrointestinal Hemorrhage; Humans; Intestines; Radionuclide Angiography; Technetium Tc 99m Sulfur Colloid

Intravenously administered dextran is used clinically as a plasma expander. The aim of this study was to assess the use of 99Tcm-dextran in the diagnosis of gastrointestinal (GI) blood leaks. Twenty-one patients with GI blood loss underwent 99Tcm-dextran scintigraphy, 17 of whom were found to be positive. Pathologic or 99Tcm-RBC (red blood cell) blood pool correlation was possible in 15 cases, while 2 were unconfirmed. No case had a positive 99Tcm-RBC blood pool study and a negative 99Tcm-dextran study. Images obtained with 99Tcm-dextran were generally better than those with 99Tcm-RBC. This agent may have several other advantages over 99Tcm-RBC blood pool and 99Tcm-sulphur colloid scintigraphy for detecting GI blood loss.

Topics: Adult; Dextrans; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Occult Blood; Organotechnetium Compounds; Radionuclide Imaging; Reference Values; Reproducibility of Results; Technetium Tc 99m Pyrophosphate; Technetium Tc 99m Sulfur Colloid

Topics: Erythrocytes; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

Detection of gastrointestinal bleeding by means of radiotracers is a non-invasive method, and should be considered when endoscopy and barium radiography have failed to identify the focus. The two most prominent tracers are 99mTc sulphur colloid and 99mTc red blood cells, and both detect lower gastrointestinal bleeding with at least the same sensitivity as angiography. A case of gastrointestinal bleeding in a 68-year old woman is presented. The bleeding source in the colon was precisely identified with the 99mTc RBC method, and was later shown to be a metastasis from her endometrial cancer.

Topics: Aged; Colonic Neoplasms; Endometrial Neoplasms; Female; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

The scintigrams of 76 patients with gastrointestinal bleeding referred over an 8 year period have been reviewed together with their subsequent clinical course. Twenty-five patients had either 99Tcm-sulphur colloid or 99Tcm-labelled red cell scintigraphy to localize a source of active bleeding. Fourteen patients had 99Tcm-sulphur colloid scintigraphy, of which seven were false negatives, two were false positives and two were true positives. Eleven patients had 12 99Tcm-labelled red cell scintigrams, of which three were false negatives, one was a false positive and four were true positives. Fifty patients had 99Tcm-pertechnetate scintigraphy to look for ectopic gastric mucosa in Meckel's diverticula. There were 43 true negatives, two false negatives, two true positives and three false positives in this group. Our results emphasize the need for caution in interpreting nuclear medicine studies in patients with blood loss from the gastrointestinal tract.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Chronic Disease; Erythrocytes; False Negative Reactions; False Positive Reactions; Female; Gastrointestinal Hemorrhage; Humans; Infant; Male; Middle Aged; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Aged, 80 and over; Female; Gastrointestinal Hemorrhage; Hematoma; Humans; Inguinal Canal; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Intra-arterial 99mTc colloid scintigraphy may have greater sensitivity than either standard intravenous scintigraphy or selective arteriography in detecting gastrointestinal bleeding. Ten millicuries of 99mTc colloid were administered directly into the superior and inferior mesenteric arteries (SMA and IMA) of patients who had undergone selective arterial catheterization for the evaluation of gastrointestinal bleeding. In one patient, 99mTc-albumin colloid was administered directly into the IMA and identified diverticular bleeding. The bleeding had been occult to prior contrast arteriography and refractory to selective intra-arterial Pitressin therapy. In a second patient who had undergone three negative provocative angiograms, selective SMA injection of 99mTc-sulfur colloid identified occult mesenteric varices secondary to portal hypertension. Selective intra-arterial scintigraphy should be valuable in detecting intestinal bleeding occult to conventional studies. This will help in directing further therapy and diagnostic evaluation.

Topics: Adult; Aged; Gastrointestinal Hemorrhage; Humans; Injections, Intra-Arterial; Male; Mesenteric Arteries; Radionuclide Angiography; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

A new experimentally proven method for diagnosis and localisation of acute bleeding in the flow area of the arteria mesenterica superior is reported. By selective intra-arterial nuclide injection microhemorrhage below the proof limit of angiography can be registered and relatively exact localized by additional geometric procedure. Using this method, the exact location of angiographic, negative bleedings could be determined in experimentally produced bleedings in the jejunoileal transit and in the distal ileum. We explain the experimental arrangement and the results. The diagnostic value of the examination is discussed.

Topics: Angiography, Digital Subtraction; Animals; Disease Models, Animal; Dogs; Gastrointestinal Hemorrhage; Iohexol; Mesenteric Arteries; Radionuclide Angiography; Technetium Tc 99m Sulfur Colloid

Topics: Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid

Complications arising from Meckel's diverticulum are uncommon in adults and are seldom, if ever, seen in the elderly. When they do occur in adults, intestinal obstruction or inflammation is the usual mode of presentation, hemorrhage being much less common. The patient described in this case report was 78 yr old, presented initially with iron deficiency anemia and, later, developed severe acute hemorrhage. The cause of the hemorrhage was ulceration at the tip of an invaginated Meckel's diverticulum. The ulceration was not peptic in origin, as is usually the case in similar presentations in children, no ectopic oxyntic mucosa being detected in the diverticulum of our patient. In previous reports, invaginated Meckel's diverticula have always been accompanied by intussusception, and abdominal pain has been an important part of the symptom complex in such patients. Our patient had no abdominal pain, and no intussusception was noted at surgery. This case emphasizes the need for considering a Meckel's diverticulum as the source of acute or chronic hemorrhage, irrespective of the patient's age. The utility of radionuclide blood pool imaging in arriving at a diagnosis in these cases is discussed.

Topics: Aged; Gastrointestinal Hemorrhage; Humans; Ileum; Intussusception; Male; Meckel Diverticulum; Radionuclide Imaging; Recurrence; Technetium Tc 99m Sulfur Colloid

Jejunal leiomyosarcoma was initially detected in a patient by a gastrointestinal bleeding scan with Tc-99m sulfur colloid (SC). The scan showed increased blood flow and delayed persistent accumulation of radiotracer in the tumor. The Tc-99m SC gastrointestinal bleeding scan provided useful information to help determine the differential diagnosis of gastrointestinal tumor with bleeding.

Topics: Female; Gastrointestinal Hemorrhage; Humans; Jejunal Neoplasms; Leiomyosarcoma; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

The authors describe a number of abnormalities that were incidentally found in a series of 132 scintigraphic studies performed for acute gastrointestinal hemorrhage. These incidental abnormalities involved the vascular system, reticuloendothelial system, and soft tissues. Correlative radiographs and computed tomographic scans are presented for some cases. The authors explore the potential impact of these abnormalities on subsequent patient evaluation and care, including radiologic workup.

Topics: Adult; Aged; Aged, 80 and over; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Infant; Male; Middle Aged; Mononuclear Phagocyte System; Pelvis; Radionuclide Imaging; Retrospective Studies; Technetium; Technetium Tc 99m Sulfur Colloid; Vascular Diseases

Topics: Aged; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Male; Radionuclide Imaging; Rectum; Technetium; Technetium Tc 99m Sulfur Colloid

Four Tc-99 radiopharmaceuticals, Tc-99m sulphur colloid, Tc-99m red blood cells (RBCs), Tc-99m mercaptoacetyltriglycine (MAG3), and Tc-99m DTPA, were studied in an experimental animal model for detection and localization of gastrointestinal (GI) bleeding site in both the upper and lower abdomen. With Tc-99m sulphur colloid and Tc-99m RBCs, it was possible to detect and localize the GI bleeding site in the lower abdomen. With Tc-99m MAG3, it was possible to visualize the bleeding site in both the upper and lower abdomen. However, Tc-99m MAG3 is partially excreted by the liver into the bile, hence it will be difficult to use Tc-99m MAG3 to localize the GI bleeding site in the lower abdomen. With Tc-99m DTPA, it was possible to detect and localize the GI bleeding site simultaneously in both upper and lower abdomen. The overall background radioactivity was reduced considerably by diuresis with frusemide and catheterization of the urinary bladder.

Topics: Animals; Erythrocytes; Gastrointestinal Hemorrhage; Oligopeptides; Organometallic Compounds; Pentetic Acid; Radionuclide Imaging; Sheep; Technetium; Technetium Tc 99m Mertiatide; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Diagnosis, Differential; False Positive Reactions; Gastrointestinal Hemorrhage; Humans; Male; Osteitis Deformans; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Erythrocytes; Gastrointestinal Hemorrhage; Humans; Organometallic Compounds; Pentetic Acid; Radionuclide Imaging; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid

The diagnostic sensitivities of arteriography, intravenous (IV) Tc-99m sulfur colloid scintigraphy, and intra-arterial (IA) Tc-99m sulfur colloid scintigraphy were evaluated in a canine model of gastrointestinal bleeding. Fifteen dogs were studied at bleeding rates ranging from .4 to 1.0 ml/minute. All three studies were obtained in six of the 15 dogs. Intravenous scintigraphy was superior to angiography in two cases, inferior in three, and equal in one. No significant difference could be shown between these two tests at these bleeding rates. Intra-arterial scintigraphy was superior to angiography in four cases and equal in two (P = .06). It was superior to IV scintigraphy in five cases and inferior in one (P = .10). In this small preliminary study, IA scintigraphy appears to be superior to the other two modalities and may prove useful in the detection of acute bleeding at the time of negative arteriography, and in serial studies in patients receiving Pitressin.

Topics: Acute Disease; Animals; Dogs; Gastrointestinal Hemorrhage; Injections, Intra-Arterial; Injections, Intravenous; Mesenteric Arteries; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Proponents of [99mTc]sulfur colloid for GI bleeding studies argue that, although labeled red blood cells are useful for intermittent bleeding, they are not capable of detecting low bleeding rates. Studies of dogs with experimental GI bleeding have indicated bleeding rates of 0.05 ml/min can be detected with [99mTc]sulfur colloid. Since similar data in the dog model were unavailable for 99mTc-labeled red blood cells, we undertook this study. To simulate lower GI bleeding, catheters were inserted into the bowel lumen. Each dog's blood was labeled with 99mTc using an in vitro technique. Venous blood was then withdrawn and re-infused into the lumen of the bowel using a Harvard pump. Fourteen dogs were studied, ten receiving a bleeding rate from 4.6-0.02 ml/min in the descending colon and four with proximal jejunal bleeds of 0.20-0.02 ml/min. Bleeding rates of 4.6-0.2 ml/min were detected within 10 min in the colon and bleeding rates as low as 0.04 ml/min were seen by 55 min. Slower bleeding rates were not detected. Similar findings were noted for proximal jejunal bleeds. Based on the time of appearance, a minimum volume of approximately 2-3 ml labeled blood was necessary to detect bleeding. We conclude that 99mTc-labeled RBCs are sensitive for low bleeding rates in the dog model. The rates are comparable to those described for [99mTc]sulfur colloid in this experimental setting. The time of appearance of activity is related to the bleeding rate.

Topics: Animals; Disease Models, Animal; Dogs; Erythrocytes; Gastrointestinal Hemorrhage; Isotope Labeling; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Intestinal Polyps; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

Scintigraphy is useful in directing the angiographer to the source of bleeding and, if negative, in precluding emergency angiography, but it is not specific enough to supplant angiography totally.

Topics: Angiography; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Choristoma; False Positive Reactions; Gastrointestinal Hemorrhage; Humans; Male; Pelvic Neoplasms; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid

Topics: Colonic Diseases; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Rectal Diseases; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Erythrocytes; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

Hemorrhage into a pancreatic pseudocyst frequently goes unrecognized. This catastrophic event can be heralded by intermittent bleeding, or may present as massive gastrointestinal hemorrhage. A high index of suspicion, proper diagnostic workup, and prompt surgical management afford the patient the best chance for survival. We report a patient with massive pseudocyst bleeding into the gastrointestinal tract via the duct of Santorini and discuss the current diagnostic and therapeutic approach.

Topics: Cholangiopancreatography, Endoscopic Retrograde; Drainage; Gastrointestinal Hemorrhage; Gastroscopy; Humans; Male; Middle Aged; Pancreatic Cyst; Pancreatic Pseudocyst; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed

Scintigram imaging is a new means of localization of digestive tract hemorrhage, the radiopharmaceutic agent (technetium-labelled colloidal sulfur or technetium-labelled erythrocytes) accumulating at the bleeding site. The technique used consists of early recording over 80 minutes and then later serial imaging over 24 hours after radioisotope injection. The limitations and advantages of radioisotope investigations are discussed in relation to results in 6 patients with digestive hemorrhage explored by scintigraphy. When technetium-labelled erythrocytes are used the method is a non-invasive, simple and sensitive one for locating site of bleeding during the period of active hemorrhage. It appears to be complementary to arteriography, a more aggressive and less sensitive procedure, and to endoscopy, which explores small intestine and cecum with difficulty and cannot always determine the origin of the bleeding when other lesions exist. Experimental studies in the dog have shown that scintigraphy can detect digestive bleeding of about 0.1 to 0.2 ml/min, and this method of exploration should be used routinely when endoscopy and/or arteriography have not been performed or have given inconclusive results.

Topics: Aged; Angiography; Child, Preschool; Endoscopy; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Technetium Tc 99m Sulfur Colloid

A case of patent arterial grafts causing an abnormal Tc-99m sulfur colloid bleeding scan is presented. This finding has not been reported previously.

Topics: Axillary Artery; False Positive Reactions; Female; Femoral Artery; Gastrointestinal Hemorrhage; Humans; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Bone Marrow; False Positive Reactions; Gastrointestinal Hemorrhage; Humans; Male; Radionuclide Imaging; Rectum; Technetium Tc 99m Sulfur Colloid

Topics: Erythrocytes; Gastrointestinal Hemorrhage; Humans; Isotope Labeling; Meckel Diverticulum; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Sclerotherapy in oesophageal variceal bleeding and portal hypertension is a standardized method. Gastro-oesophageal reflux-scintigraphy was performed in 18 from 90 patients. Augmented reflux of gastric acid and signs of insufficiency could not be shown. Our results indicate that a general treatment for avoiding a relapse of variceal bleeding by reflux is not necessary.

Topics: Esophageal and Gastric Varices; Esophageal Stenosis; Esophagogastric Junction; Esophagus; Gastroesophageal Reflux; Gastrointestinal Hemorrhage; Humans; Liver Cirrhosis; Radionuclide Imaging; Sclerosing Solutions; Technetium Tc 99m Sulfur Colloid

Colonic angiodysplasia is now recognized as a frequent cause of gastrointestinal bleeding in patients over age 55. These microvascular arteriovenous malformations may be as common a cause of colonic bleeding as diverticular disease. The lesions are not evident on barium studies. Even colonoscopy and selective colonic angiography can give false-negative results. Therefore, repeated studies for recurrent episodes of bleeding are often necessary before the diagnosis is made. Methods of treatment include coagulation biopsy, segmental colon resection and right hemicolectomy.

Topics: Angiography; Arteriovenous Malformations; Colectomy; Colon; Colonoscopy; Diagnosis, Differential; Diverticulitis, Colonic; Gastrointestinal Hemorrhage; Humans; Middle Aged; Technetium Tc 99m Sulfur Colloid

Massive lower gastrointestinal (GI) bleeding caused by gallbladder carcinoma eroding into the colonic wall was demonstrated accurately by Tc-99m RBCs. In addition, retrograde bleeding into the gallbladder was also identified while arteriography did not show contrast extravasation. This case supports the use of Tc-99m RBCs over Tc-99m sulfur colloid for more accurate localization of lower GI bleeding.

Topics: Acute Disease; Aged; Biliary Fistula; Colonic Diseases; Erythrocytes; Female; Gallbladder Diseases; Gallbladder Neoplasms; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

Twenty-seven paired Tc-99m sulfur colloid (SC) and Tc-99m RBC studies were evaluated for the detection of GI bleeding. The only two positive Tc-99m SC studies had positive early Tc-99m RBC studies as well. There were 15 other positive Tc-99m RBC studies (three during the first hour) and these were associated with normal Tc-99m SC scans. Approximately 70% of the positive Tc-99m RBC studies occurred after 1 hour. Tc-99m RBCs should be the initial test in patients with GI bleeding.

Topics: Adolescent; Adult; Aged; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

Repeated scintigraphy was performed for 6 days after the injection of autologous 111In-labeled platelets in a patient showing signs of recurrent occult gastrointestinal bleeding. Colonic activity was observed 142 h post injection, at which time a superimposed study using 99mTc sulphur colloid pinpointed the source of bleeding in the transverse colon.

Topics: Aged; Blood Platelets; Female; Gastrointestinal Hemorrhage; Humans; Indium; Radioisotopes; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Partial splenic embolization (PSE) was successfully accomplished in 10 of 11 children, aged 2-9, who had portal hypertension or variceal bleeding. Nine of the 11 children had undergone portoenterostomy (Kasai operation) for biliary atresia, and two had portal vein thrombosis. After embolization these children had a longer period of fever (mean = 23.7 days) and elevated white blood cell (WBC) count (above 10,000, mean = 13.6 days) than adults who have undergone the same procedure. The leukopenia and thrombocytopenia of hypersplenism were corrected by PSE in seven of eight children, and the condition of the eighth child improved. Among ten patients who had experienced episodes of variceal hemorrhage, the frequency of bleeding episodes was reduced from an average of 2.87 per year before PSE to 0.67 per year after PSE. There were no splenic abscesses and no other significant complications of the treatment. Ultrasound (US) evaluation after embolization demonstrated hypoechogenicity of the infarcted areas and tiny, linear echoes scattered throughout the spleen typical of postinfarction intravascular gas. All nine children who underwent follow-up Tc-99m sulfur colloid scanning showed evidence of splenic regeneration, though none has had recurrence of clinical symptoms. Splenic regeneration following PSE may occur more frequently in children than in adults.

Topics: Child; Child, Preschool; Embolization, Therapeutic; Esophageal and Gastric Varices; Female; Gastrointestinal Hemorrhage; Humans; Hypersplenism; Male; Radionuclide Imaging; Spleen; Splenic Artery; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed; Ultrasonography

13 patients with gastrointestinal hemorrhage underwent a scintigraphic examination to localize the bleeding. In 6 patients Tc-99m labeled red blood cells, in 7 patients Tc-99m sulfur colloid were used. Scintigraphy could demonstrate an intestinal bleeding in ten patients, in whom the conventional examinations, and among them 7 abdominal angiographies had failed. 5 of them had to be operated after that, whereby the scintigraphic findings were verified. One of the three patients with negative scintigraphy had to undergo an operation because of continuous bleeding. The methods of scintigraphy and their indication in gastrointestinal hemorrhage are discussed.

Topics: Adult; Aged; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Melena; Middle Aged; Pentetic Acid; Radionuclide Imaging; Rectum; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid

99Tcm-DTPA has been evaluated in our clinical and experimental programme for the detection of acute gastrointestinal bleeding. As an adjunct to this programme, a protocol for image subtraction has been developed. The patient remains still while sequential static images I(i) (i = 1, . . ., N) are taken. They are first normalized to equal total counts and then subtracted images are produced according to the following three methods (a) I(i + 1)-I(i) (b) I(i) - I(mask) (c) I(mask) - I(i) where i not equal to mask and I(mask) denotes a user-selected mask image. Method (a) demonstrates fresh bleeding and sequential movement of blood in the bowel. Methods (b) and (c) demonstrate overall migration of blood and accumulated bleeding depending on the choice of the mask image.

Topics: Acute Disease; Colon; Duodenal Ulcer; Erythrocytes; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Pentetic Acid; Peptic Ulcer Hemorrhage; Radionuclide Imaging; Stomach Ulcer; Subtraction Technique; Technetium; Technetium Tc 99m Pentetate; Technetium Tc 99m Sulfur Colloid

The use of radionuclide gastrointestinal scanning with 99mTc sulfur colloid, supplementing angiography, is described in the diagnosis of the source of bleeding in a 60-year-old woman with neurofibromatosis. These two procedures succeeded in locating the origin of bleeding from neurofibroma in the jejunum, which was corrected by surgery. To our knowledge, this case report is the first description of a patient with neurofibromatosis, with all the reported gastrointestinal symptoms: intermittent abdominal pains, palpable abdominal mass, gastrointestinal bleeding and small bowel obstruction.

Topics: Digestive System; Female; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Ileocecal Valve; Intestinal Neoplasms; Intussusception; Melena; Middle Aged; Neurofibromatosis 1; Radiography; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

The relative efficacy of 99mTc sulfur colloid and in vitro-labeled 99mTc red blood cells in detecting and localizing gastrointestinal hemorrhage was evaluated in a prospective tandem study of 100 patients referred for suspicion of gastrointestinal tract hemorrhage. Thirty-eight true-positive scintigrams were obtained with 99mTc red blood cells, whereas 99mTc sulfur colloid detected only five sites of hemorrhage. Scintigraphic findings were corroborated by clinical, endoscopic, arteriographic, and surgical findings. 99mTc red blood cells were clearly superior, with a sensitivity of 93%, specificity of 95%, and overall accuracy of 94% in detecting and localizing gastrointestinal hemorrhage.

Topics: Adolescent; Adult; Aged; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Prospective Studies; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Aged; Endoscopy; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Adolescent; Adult; Aged; Child; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Aged; Colloids; Erythrocytes; Gastrointestinal Hemorrhage; Humans; Liver Neoplasms; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Intrapenile blood pool activity may be a source of artefact in interpreting a gastrointestinal bleeding study employing Tc-99m sulfur colloid or erythrocytes. Proper positioning should avoid a false reading of rectal bleeding.

Topics: Erythrocytes; Gastrointestinal Hemorrhage; Humans; Male; Penis; Radionuclide Imaging; Rectum; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Acute Disease; Aged; Colloids; Erythrocytes; Female; Gastrointestinal Hemorrhage; Humans; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

The use of scintigraphic imaging in the evaluation of gastrointestinal (GI) hemorrhage has been established recently as a screening procedure prior to anigography. We report an unusual and previously unreported cause of acute GI bleeding which illustrates several technical factors to be considered during scintigraphic evaluation of GI bleeding.

Topics: Colonic Diseases; Female; Fistula; Gastrointestinal Hemorrhage; Humans; Iliac Artery; Intestinal Fistula; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Dynamic radionuclide angiography (5-sec. images) with technetium-99m-sulfur colloid proved to be helpful in 5 patients who presented with gastrointestinal bleeding. In 2, intermittently bleeding hypervascular lesions were seen on dynamic but not on static images; in 2 others, the dynamic images demonstrated hypervascular lesions better than the static scans; and in 1, the radionuclide angiogram localized colonic bleeding more accurately because of rapid peristalsis of extravasated tracer. The addition of the radionuclide angiogram to routine scintigraphy for gastrointestinal bleeding may be crucial for identification of hypervascular lesions and precise localization of bleeding sites.

Topics: Adult; Aged; Diagnosis, Differential; Female; Gastrointestinal Hemorrhage; Humans; Male; Melena; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

Recent experience with radionuclide imaging has provided the clinician with several techniques to noninvasively detect and locate sources of gastrointestinal hemorrhage. These tests can be rapidly performed and often in an ICU setting. One method used Tc-99m sulfur colloid which, in an animal model, has been shown to detect acute bleeding at rates as low as 0.1 ml/min. However, because the tracer remains in the blood for a short period of time, it may be suboptimal for identifying patients with intermittent bleeding. Tc-99m red cells is a tracer that remains within the blood and permits detection of both acute and intermittent bleeding. With tagged red cells, sites of bleeding from both the upper and lower gastrointestinal tract can be found. Both of these techniques can provide important information in the patient with suspected active gastrointestinal bleeding and aid the clinician in more effective management including the use of invasive diagnostic and therapeutic techniques.

Topics: Aged; Erythrocytes; Female; Gastrointestinal Hemorrhage; Half-Life; Humans; Infant; Male; Meckel Diverticulum; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

A 36-year-old man was transferred to our department because of massive malena followed by shock. Gastroduodenal endoscopy revealed no bleeding source in the stomach or the duodenum. RI-angiogram performed immediately after admission revealed a bleeding area at the jejunum and laparotomy was done. The bleeding lesion was detected by exploratory jejunotomy and a jejunectomy was successfully performed over 15 cm, including the lesion. RI-angiogram is useful as selective angiography in the diagnosis of intestinal bleeding and is less invasive.

Topics: Adult; Angiography; Gastrointestinal Hemorrhage; Humans; Jejunal Diseases; Jejunum; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

A retrospective review of two years' experience with radionuclide screening to detect lower gastrointestinal bleeding sites was conducted at New York's Montefiore Medical Center. Of 82 studies performed in 63 patients, 13 identified active bleeding sites. Only three of eight angiograms obtained in these 13 patients were positive. Thirteen contrast angiograms were performed in the group of 50 patients with negative radionuclide studies of which ten were negative and one was equivocal. The results of this study suggest that the Tc-99m sulfur colloid study for active lower gastrointestinal (GI) bleeding is an effective screening procedure. Positive studies help determine which vessel to catheterize selectively if an angiogram is to be performed. If vascular ectasis is still suspected following a negative radionuclide study, contrast angiography can be more efficaciously performed on a nonemergent basis.

Topics: Adult; Aged; Angiography; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

A retrospective review of 80 scintigraphic bleeding studies performed with Tc-99m sulfur colloid or Tc-99m labeled red blood cells showed five cases where there were abnormal findings not related to bleeding. In some cases, the abnormalities were initially confused with bleeding or could obscure an area of bleeding, while in other cases, the abnormalities represented additional clinical information. These included bone marrow replacement related to tumor and radiation therapy, hyperemia related to a uterine leiomyoma and a diverticular abscess, and a dilated abdominal aorta (aneurysm). Recognition of such abnormalities should prevent an erroneous diagnosis and the additional information may be of clinical value.

Topics: Aged; Female; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Abdomen; Aged; Colloids; Gastrointestinal Hemorrhage; Hemorrhage; Humans; Meckel Diverticulum; Radiography; Radionuclide Imaging; Rectal Diseases; Sigmoid Diseases; Sodium Pertechnetate Tc 99m; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Erythrocytes; Evaluation Studies as Topic; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

A Tc-99m-sulfur colloid abdominal scan was performed on a 12-year-old girl to localize the site of gastrointestinal bleeding. The study was normal. When bleeding recurred two weeks later, a repeat study revealed a focal abnormality in the upper abdomen. This was thought to be compatible with a small bleed. However, at surgery an accessory spleen was found, accounting for the abnormal scan.

Topics: Child; False Positive Reactions; Female; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Spleen; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adult; False Negative Reactions; Female; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Time Factors

We have developed a single scintigraphic technique to detect and localize the site of bleeding in the gastrointestinal tract. This examination requires only intravenous administration of 99m-Technetium sulfur colloid and imaging of the abdomen. Very shortly after the introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. This phenomenon is repeated each time the blood recirculates adding another, but smaller fraction to the extravasated activity at the site of hemorrhage. Because of continued clearance of the radiopharmaceutical from the vascular pool by the reticuloendothelial system, a contrast is eventually reached between the site of bleeding and surrounding background. Based on animal experiments bleeding rates as low as .05-0.1 cc/min can be detected with this technique. The sensitivity of the approach in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques which utilize radioactive blood pool indicators. We have mainly used this technique in the evaluation of patients with GI bleeding. In more than 25 patients with negative scintigrams for hemorrhage, arteriography showed no evidence of bleeding. In 38 patients with scintigraphic evidence of bleeding. In 38 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding in les than 50% of the cases. No false positive results have been noted in the latter group. This technique appears to offer a simple, practical and reliable approach to the evaluation of patients with gastrointestinal bleeding.

Topics: Angiography; Colloids; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Varicose Veins

99mTc sulfur colloid scintigraphy is a technique which can be used to localize sites of lower gastrointestinal hemorrhage. Two reports of patients illustrate its use clinically. This procedure is non-invasive, relatively inexpensive, easily performed and has a high degree of sensitivity. The technique may, in some instances, replace angiography or endoscopy as the initial procedure used to diagnose the site of lower gastrointestinal bleeding or, more likely, serve as a complementary diagnostic modality.

Topics: Aged; Arteriovenous Malformations; Colloids; Colonic Neoplasms; Gastrointestinal Hemorrhage; Humans; Ileal Diseases; Ileum; Male; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Female; Gastrointestinal Hemorrhage; Humans; Mesenteric Arteries; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Acute Disease; Cholecystitis; Esophageal Diseases; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Humans; Imino Acids; Indium; Leukocytes; Meckel Diverticulum; Organotechnetium Compounds; Radioisotopes; Radionuclide Imaging; Stomach Diseases; Sulfur; Technetium; Technetium Tc 99m Diethyl-iminodiacetic Acid; Technetium Tc 99m Disofenin; Technetium Tc 99m Sulfur Colloid; Technology, Radiologic

Active lower intestinal bleeding from a Meckel's diverticulum in an infant was detected with Tc-99m-sulfur colloid scintigraphy. This technique expands the scintigraphic armamentarium for evaluation of lower intestinal bleeding in infants and children.

Topics: Diagnosis, Differential; Gastrointestinal Hemorrhage; Humans; Infant; Intestine, Small; Male; Meckel Diverticulum; Radionuclide Imaging; Rectum; Sodium Pertechnetate Tc 99m; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

The management of patients with gastrointestinal (GI) bleeding depends on accurate localization of the site of hemorrhage. Endoscopy and arteriography, although successful in achieving this goal in the majority of patients, are invasive and have other shortcomings. The introduction of the 99mTc-sulfur colloid technique has greatly simplified the evaluation and management of these patients. This test is useful in detecting and localizing the bleeding site in the lower GI tract. Scintigraphy is now used as the initial study of choice in patients with rectal bleeding. Advances made in angiography and nuclear medicine techniques also have resulted in improved management of patients. Conservative approaches succeed in controlling hemorrhage in most patients. Vasopressin is the most widely tested agent and has been adopted by many as the preferred preparation for this purpose. Before the introduction of the 99mTc-sulfur colloid technique, angiography was used to monitor the effectiveness of this drug, whether administered intravenously or intraarterially. With the use of scintigraphy and intravenous administration of vasopressin, these patients now can be managed noninvasively. Only when the intravenous Pitressin infusion fails to stop hemorrhage, is the intraarterial approach considered. Surgery is used as a last resort when these measures fail to stop the bleeding.

Topics: Colon, Sigmoid; Contrast Media; Gastrointestinal Hemorrhage; Humans; Injections, Intra-Arterial; Injections, Intravenous; Radiography; Radionuclide Imaging; Sigmoid Diseases; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Vasopressins

Preliminary experience with technetium-99m sulfur colloid scintigraphy in 43 patients with lower gastrointestinal bleeding is described. Within minutes of the intravenous introduction of the radiopharmaceutical, a fraction of the injected activity extravasates at the bleeding site and is eliminated from the circulation. Because of rapid clearance of the radiopharmaceutical from the vascular pool by the reticuloendothelial system, a contrast develops between the site of bleeding and surrounding background. Based on animal experiments, bleeding rates as low as 0.05-0.1 ml/min can be detected with this technique. The sensitivity of this technique in the detection of the site of hemorrhage is significantly higher than arteriography or other techniques that use radioactive blood pool indicators. In this study all patients underwent both scintigraphy and arteriography within several hours. In 20 patients with negative scintigrams, arteriography showed no evidence of bleeding. In the other 23 patients with scintigraphic evidence of hemorrhage, arteriograms were positive for bleeding only in 10. In 19 of the 23 patients, a cause for bleeding was eventually established by other means. This technique appears to offer a simple, practical, and reliable approach to the evaluation of patients with lower gastrointestinal bleeding.

Topics: Angiography; Gastrointestinal Hemorrhage; Humans; Methods; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Abdomen; Aged; Animals; Barium Sulfate; Enema; Gastrointestinal Hemorrhage; Humans; Intestinal Neoplasms; Leiomyoma; Leiomyosarcoma; Male; Middle Aged; Pain; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Abdominal Injuries; Adult; Gastrointestinal Hemorrhage; Humans; Male; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Wounds, Nonpenetrating

Topics: Diagnosis, Differential; Gastrointestinal Hemorrhage; Humans; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Acute gastrointestinal bleeding may be localized using noninvasive radionuclide methods. We have favored the use of technetium-99m sulfur colloid with sequential imaging because of the rapid clearance of background activity. Definition of the site of upper gastrointestinal bleeding, however, may be obscured by intense uptake of radioactivity by liver and spleen. The sensitivity of the method is such that the bleeding rates of 0.05-0.1 ml/min can be detected compared to a sensitivity of 0.5 ml/min for angiography.

Topics: Acute Disease; Gastrointestinal Hemorrhage; Humans; Methods; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid