Role of multidetector computed tomography angiography in non-variceal upper gastrointestinal bleeding: A comprehensive review

Table 1 Summary of studies reporting on the role of multidetector computed tomography in the diagnosis of acute Non-variceal upper gastrointestinal bleeding

Ref.	Study design	Patients, n	Type of CT	Inclusion criteria	Exclusion criteria	Criteria for positive CT	Reference standard	Study aim	Results
Yoon et al[20], 2006	P	7	4-MDCT	Patients with massive UGIB in whom endoscopic examination or hemostasis failed	-	Active GIB: Extravasation of CM with attenuation> 90 HU within bowel lumen	Angiography	Accuracy of MDCT for detection and localization of acute massive UGIB	GIB detection: TP: 4/7, FN: 2/7, FP: 1/7, TN: 0/7, GIB localization: TP: 7/7
Scheffel et al[21], 2007	R	10	4-, 16-, or 64- MDCT	Patients with UGIB who underwent CT in the acute phase of hemorrhage	-	Acute GIB: Active extravasation of CM within bowel lumen; or extravasated CM with attenuation > 90 HU	Surgery, angiography, endoscopy, or pathology	Ability of MDCT to identify source and etiology of acute UGIB	GIB detection: 10/10; GIB etiology identification: 9/10
Jaeckle et al[22], 2008	R	10	16- or 40-MDCT	Patients with UGIB in whom endoscopic examination failed to identify the bleeding source	Serum creatinine > 250 µmol/L; or iodinated CM allergy	Active GIB: Active extravasation of CM with attenuation > 90 HU within bowel lumen; or collection of hyperdense intraluminal blood with attenuation > 90 HU	Endoscopy, angiography and/or surgery	Accuracy of MDCT for detection and localization of acute UGIB	GIB detection: TP: 9/10; FN: 1/10; GIB localization: TP: 9/10; FN: 1/10
Fung et al[23], 2008	R	6	64-MDCT	Patients with UGIB who underwent angiography	-	Acute GIB: Mass, abnormal vessel, or active extravasation of CM within bowel lumen	Angiography	Accuracy of MDCT for detection of acute UGIB	TP: 6/6
Frattaroli et al[24], 2009	P	11 (1 VUGIB)	16-MDCT	Patients with severe acute UGIB following endoscopy	Hemodynamicinstability; non-severe, intermittent, or chronic GIB; or effective endoscopic hemosthasis	Acute GIB: Active extravasation of CM within bowel lumen	Endoscopy, angiography, surgery, or post-mortem findings	Ability of MDCT to identify UGIB site and etiology	GIB site identification: Sensitivity 100% (vs 72.7% of endoscopy); GIB etiology identification: Sensitivity 90.9% (vs 54.5% of endoscopy)
Sun et al[25], 2012	P	33	16-, 64-, or dual-source MDCT	Patients with acute UGIB who underwent; MDCT as the initial diagnostic examination	Iodinated CM allergy; pregnancy; or serum creatinine > 2.0 mg/dL	Active GIB: Active extravasation of CM with attenuation > 90 HU within bowel lumen; focal or segmental abnormal bowel mucosal enhancement; presence of a vascular malformation; polyp or diverticulum with abnormal enhancement; or tumor	Endoscopy, angiography, surgery, or pathology	Accuracy of MDCT for detection of active UGIB	TP: 25/33; FN: 3/33; TN: 5/33
Miyaoka et al[26], 2014	R	330	64-MDCT	Patients with acute UGIB who underwent MDCT prior to urgent endoscopy	Patients who underwent other therapeutic modalities rather than urgent endoscopy due to MDCT findings	Active GIB: Extravasation of CM within bowel lumen; possible bleeding: Wall thickening; focal wall enhancement; masses, varices, and aneurysms, with or without the intraluminal high-attenuation substance	Endoscopy	Accuracy of MDCT for detection of acute UGIB origin	Enhanced MDCT: 57.8% (130/227); unenhanced MDCT: 19.4% (20/103)
Jono et al[28], 2019	R	386	16- or 64- MDCT	Patients with NVUGIB who underwent MDCT prior to urgent endoscopy	VUGIB; or no CT exam	UGI hemorrhage: Yes or no; UGI wall change: Concavity or hypertrophy	Endoscopy	OR of risks scores based on clinical data and CT findings for predicting mortality, rebleeding and need for endoscopic therapy in NVUGIB	UGI hemorrhage: Not significant in predicting mortality and rebleeding, but significant in predicting need for endoscopic therapy (OR 10.1 for RS and 10.70 for GBS); UGI wall change: Not significant in predicting mortality, rebleeding and need for endoscopic therapy
Kim et al[27], 2022	R	269 (53 VUGIB)	64-MDCT	Patients with acute UGIB who underwent MDCT prior to endoscopy	Execution of endoscopy 24 h after admission; endoscopic examination failure; LGIB; acute or chronic kidney injure; or iodinated CM allergy	Active bleeding: Active extravasation of CM within bowel lumen; recent bleeding: Hemorrhagic content, suspicious hematoma, and blood clots	Endoscopy	Accuracy of MDCT for identification of status, location, and etiology of UGIB	Bleeding status identification: 32.9% (active bleeding); 27.4% (recent bleeding); 94.8% (no bleeding); bleeding location identification: 60.9% (esophagus), 60.6% (stomach), 50.9% (duodenum); bleeding etiology identification: 58.3% (ulcerative bleeding), 65.9% (cancerous bleeding), 56.6% (variceal bleeding)

CT: Computed tomography; MDCT: Multidetector-row computed tomography; UGIB: Upper gastrointestinal bleeding; GIB: Gastrointestinal bleeding; CM: Contrast medium; HU: Hounsfield units; TP: True positive; FN: False negative; FP: False positive; TN: True negative; VUGIB: Variceal upper gastrointestinal bleeding; UGI: Upper gastrointestinal; OR: Odds ratio; RS: Rockall score; GBS: Glasgow-Blatchford score; LGIB: Lower gastrointestinal bleeding.