Gastrointestinal Kanama Yeri Değerlendirilmesinde SPECT/BT’nin Tanısal Yeteneği ve Katkısı: Özellikle Ameliyat Öyküsü Bulunan Hastalarda

The Diagnostic Contribution of SPECT/CT Imaging in the Assessment of Gastrointestinal Bleeding: Especially for Previously Operated Patients

Abstract

Amaç: Gastrointestinal kanama (GİK), başarılı bir tedavi için multidisipliner yaklaşım gerektiren hayati önemde bir sorundur. Çalışmamızda akut kanama tanısında tek foton emisyonlu bilgisayarlı tomografi/bilgisayarlı tomografinin (SPECT/BT) klinik katkısını vurgulamayı amaçladık. Yöntem: Üç yıllık bir dönemde akut GİK şüphesi ile nükleer tıp bölümüne başvuran 14 hastanın tümü retrospektif olarak incelendi. Sintigrafik bulguları, SPECT/BT çalışmalarında BT kısmının korelatif katkısına vurgu yaparak değerlendirebilmek için klinik kayıtlar analiz edildi. Bulgular: Beş hastanın dinamik ve statik görüntüleme bulguları negatifti. Planar görüntülerde pozitif bulguları olan 9 hastaya SPECT/BT yapıldı. SPECT/BT, abdominal cerrahi öyküsü olan dört hastada anastomozdan kaynaklanan kanama yerini tam olarak gösterdi. Serviks kanseri tanılı bir hastada çekumdan kanama gösterildi. SPECT/BT, mesane kanseri olan bir hastanın primer tümörünün arka duvarından kaynaklanan kanama

Özet

Objectives: Gastrointestinal bleeding (GIB) is a life-threatening problem that requires a multidisciplinary approach for successful treatment. This study aims to emphasize the clinical contribution of single photon emission computed tomography/computed tomography (SPECT/CT) for the diagnosis of acute bleeding. Methods: All 14 patients referred to the nuclear medicine department in 3 years with suspicion of acute GIB were evaluated retrospectively. Clinical records were analyzed to assess the scintigraphic findings, emphasizing the correlative contribution of the CT portion on SPECT/CT studies. Results: Five patients were negative on dynamic and static planar images. SPECT/CT was performed in 9 patients who had positive findings on planar imaging. SPECT/CT could identify the same bleeding site originating from the anastomosis in four patients with a history of abdominal surgery. SPECT/CT confirmed bleeding from the cecum in a patient with cervical cancer. SPECT/CT showed the bleeding focus in the bladder neck of a patient with bladder cancer and the bleeding from peritoneal metastases of a patient with gastric cancer. In 1 patient, the right upper quadrant activity accumulation, which may cause false positives, was found to be the gallbladder on SPECT/CT. Delayed images showed the true bleeding focus in the cecum. In 1 patient, suspicious activity accumulation in the midline of the abdomen was found to be due to a previously unknown aortic aneurysm on SPECT/CT. Conclusion: SPECT/CT imaging is a feasible technique to facilitate image interpretation in patients with GIB. SPECT/CT imaging can guide the surgeon through more accurate localization. Therefore, for proper patient management, SPECT/CT should be applied to detect the bleeding focus, if present, especially in patients who had undergone a previous operation.