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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding: A useful predictor of positive angiographic findings
Laura Maria Cacioppa, Chiara Floridi, Alessandra Bruno, Nicolò Rossini, Tommaso Valeri, Alessandra Borgheresi, Riccardo Inchingolo, Francesco Cortese, Giacomo Novelli, Alessandro Felicioli, Mario Torresi, Pietro Boscarato, Letizia Ottaviani, Andrea Giovagnoni
Laura Maria Cacioppa, Chiara Floridi, Alessandro Felicioli, Mario Torresi, Pietro Boscarato, Division of Interventional Radiology, Department of Radiological Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
Laura Maria Cacioppa, Chiara Floridi, Alessandra Bruno, Nicolò Rossini, Tommaso Valeri, Alessandra Borgheresi, Andrea Giovagnoni, Department of Clinical, Special and Dental Sciences, University Politecnica Delle Marche, Ancona 60126, Italy
Laura Maria Cacioppa, Chiara Floridi, Laura Maria Cacioppa and Chiara Floridi.
Chiara Floridi, Letizia Ottaviani, Andrea Giovagnoni, Division of Radiology, Department of Radiological Sciences, University Hospital "Azienda Ospedaliero Universitaria Delle Marche", Ancona 60126, Italy
Riccardo Inchingolo, Francesco Cortese, Interventional Radiology Unit, "F Miulli" Regional General Hospital, Acquaviva delle Fonti 70021, Italy
Giacomo Novelli, Department of Radiology, IRCCS INRCA, Ancona 60126, Italy
Author contributions: Floridi C and Cacioppa LM contributed equally to this work and share the first authorship, and they made a significant contribution to study design formulation, to data acquisition, analysis, and interpretation, to the actual manuscript preparation, and to the critical revision of the publication’s intellectual content of the work being published; Cacioppa LM, Floridi C, Borgheresi A, Inchingolo R, and Cortese F designed the research study; Bruno A, Rossini N, Valeri T, and Novelli G performed the research; Felicioli A, Torresi M, Boscarato P, and Ottaviani L contributed new reagents and analytic tools; Cacioppa LM, Floridi C, and Giovagnoni A analyzed the data and wrote the manuscript; all authors have read and approved the final manuscript.
Institutional review board statement: The study was approved by the Internal Review Board and was conducted in conformity to the ethics guidelines of the 1990 Declaration of Helsinki and its amendments. Due to the retrospective design, this study did not require the approval by the Ethics Committee of the University Politecnica delle Marche.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data collected during the study are available from the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Riccardo Inchingolo, MD, Director, Doctor, Interventional Radiology Unit, "F Miulli" Regional General Hospital,
via di Santeramo, Acquaviva delle Fonti 70021, Italy.
riccardoin@hotmail.it
Received: January 30, 2024
Revised: March 19, 2024
Accepted: April 16, 2024
Published online: May 28, 2024
Processing time: 115 Days and 5 Hours
BACKGROUND
Gastrointestinal bleeding (GIB) is a severe and potentially life-threatening condition, especially in cases of delayed treatment. Computed tomography angiography (CTA) plays a pivotal role in the early identification of upper and lower GIB and in the prompt treatment of the haemorrhage.
AIM
To determine whether a volumetric estimation of the extravasated contrast at CTA in GIB may be a predictor of subsequent positive angiographic findings.
METHODS
In this retrospective single-centre study, 35 patients (22 men; median age 69 years; range 16-92 years) admitted to our institution for active GIB detected at CTA and further submitted to catheter angiography between January 2018 and February 2022 were enrolled. Twenty-three (65.7%) patients underwent endoscopy before CTA. Bleeding volumetry was evaluated in both arterial and venous phases via a semi-automated dedicated software. Bleeding rate was obtained from volume change between the two phases and standardised for unit time. Patients were divided into two groups, according to the angiographic signs and their concordance with CTA.
RESULTS
Upper bleeding accounted for 42.9% and lower GIB for 57.1%. Mean haemoglobin value at the admission was 7.7 g/dL. A concordance between positive CTA and direct angiographic bleeding signs was found in 19 (54.3%) cases. Despite no significant differences in terms of bleeding volume in the arterial phase (0.55 mL vs 0.33 mL, P = 0.35), a statistically significant volume increase in the venous phase was identified in the group of patients with positive angiography (2.06 mL vs 0.9 mL, P = 0.02). In the latter patient group, a significant increase in bleeding rate was also detected (2.18 mL/min vs 0.19 mL/min, P = 0.02).
CONCLUSION
In GIB of any origin, extravasated contrast volumetric analysis at CTA could be a predictor of positive angiography and may help in avoiding further unnecessary procedures.
Core Tip: Computed tomography angiography (CTA) plays a pivotal role in the diagnostic-therapeutic management of gastrointestinal bleeding (GIB). Since a large portion of GIB cases detected by CTA are occult on catheter angiography, our study aimed to evaluate whether the volumetric assessment of extravasated contrast through a semiautomated software could be identified as a predictive factor for positive angiography. The bleeding volume in the venous phase and the bleeding rate were significantly associated with positive angiographic findings. The reproducibility of the volumetric analysis was also demonstrated by a significant inter-observer agreement between two radiologists with different levels of experience.
