Case 35 cont'd
The SPECT and SPECT CT images localized the tracer accumulation in distal small bowel.
Findings corroborated with Abdominal CT angiography 3 days later. The patient died 12 days after the study due to LOC and aspiration pneumonia.
What are the radiotracers used in NM for GI bleeding studies?
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TC 99m labeled RBC
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Tc99m SC
How much is the lowest bleeding rate to be detected by nuclear GI bleeding study and CTA?
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TC 99m labeled RBC:0.05-0.1 ml/min [2]
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Tc99m SC: 0.05ml/min
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Ct angiography:≥ 0.35 ml/min [1]
What type of pharmacologic intervention can be done for GI bleeding study?
Glucagon has been suggested as an adjunct to GI bleeding studies. Glucagon decreases intestinal peristalsis and increases vasodilatation. However, Glucagon is not widely used.
Glucagon, UFH 6000U + 1000U/H
References:
1. Ford, Patrick V., et al. "Procedure guideline for gastrointestinal bleeding and Meckel's diverticulum scintigraphy." Journal of Nuclear Medicine 40.7 (1999): 1226-1232.
2. Wortman, Jeremy R., et al. "CT angiography for acute gastrointestinal bleeding: what the radiologist needs to know." The British journal of radiology 90.1075 (2017): 20170076.