Extravasated contrast volumetric assessment on computed tomography angiography in gastrointestinal bleeding: A useful predictor of positive angiographic findings

Figure 1 Box-plot graphical representations comparing concordance and no-concordance groups. A: Box-plot graphical representation of age distribution in the two study groups; B: Box-plot graphical representation of bleeding venous volume distribution in the two study groups; C: Box-plot graphical representation of computed tomography angiography-angiography time interval distribution in the two study groups; D: Box-plot graphical representation of bleed rate distribution in the two study groups. CECT-DSA: Contrast-enhanced computed tomography-digital subtraction angiography.

Figure 2 Bland-Altman plot for inter-reader agreement of volumetric analyses. A: Arterial phase volumes: 2/35 (5.71%) outside "agreement" limits. Mean difference, -0.05; upper agreement limit, 0.98; lower agreement limit, -1.98; B: Venous phase volumes: 1/35 (2.86%) outside the agreement limits. Mean difference, -0.56; upper agreement limit, 5.03; lower agreement limit, -6.15.

Figure 3 Example case of a 63-year-old man with jejunal gastrointestinal bleeding detected at computed tomography angiography and evaluated with a semiautomated software (bleeding rate: 5. 397 mL/min) and not confirmed by catheter angiography (non-concordance group). A: Computed tomography angiography (CTA) in the arterial phase showing jejunal gastrointestinal bleeding (GIB) on axial view; B: CTA in the venous phase showing jejunal GIB on axial view; C: GIB volume evaluation in the arterial phase of axial CTA with a semiautomatic software on a dedicated workstation. Bleeding volume was 0.330 mL; D: GIB volume evaluation in the venous phase of axial CTA with a semiautomatic software. Bleeding volume in the venous phase was 0.769 mL; E: GIB volume evaluation in the arterial phase of coronal CTA; F: GIB volume evaluation in the venous phase of coronal CTA; G: GIB volume evaluation in the arterial phase of sagittal CTA; H: GIB volume evaluation in the arterial phase of sagittal CTA; I: Catheter angiography of superior mesenteric artery showing no signs of bleeding; J-L: Superior mesenteric artery angiograms after multiple selective and super selective catheterisms of distal branches showing no signs of bleeding.

Figure 4 Example case of a 71-year-old man with ileal gastrointestinal bleeding detected at computed tomography angiography and evaluated with a semiautomated software (bleeding rate: 0. 585 mL/min) and confirmed by catheter angiography (concordance group). A: Computed tomography angiography (CTA) in the arterial phase showing jejunal gastrointestinal bleeding (GIB) on axial view; B: CTA in the venous phase showing jejunal GIB on axial view; C: GIB volume evaluation in the arterial phase of axial CTA with a semiautomatic software on a dedicated workstation. Bleeding volume was 0.160 mL; D: GIB volume evaluation in the venous phase of axial CTA with a semiautomatic software. Bleeding volume in the venous phase was 5.397 mL; E: GIB volume evaluation in the arterial phase of coronal CTA; F: GIB volume evaluation in the venous phase of coronal CTA; G: GIB volume evaluation in the arterial phase of sagittal CTA; H: GIB volume evaluation in the arterial phase of sagittal CTA; I: Catheter angiography of superior mesenteric artery showing signs of bleeding; J and K: Selective and super-selective angiograms of ileal branches of the superior mesenteric artery showing signs of bleeding; L: Transarterial embolization with mechanical agents; M: Final angiography showing effective treatment with no signs of bleeding.