DIAGNOSTIC VALUE OF COMPUTED TOMOGRAPHY ANGIOGRAPHY IN THE DIAGNOSIS OF GASTROINTESTINAL HEMORRHAGE

Nguyễn Thị Mai Hạnh 1, 2 , , Huỳnh Chung 2 , Đỗ Võ Công Nguyên 1
1 Thong Nhat Hospital image/svg+xml
2 Pham Ngoc Thach University of Medicine image/svg+xml
* Corresponding author:

Article Information

Metrics
Downloads: 0 Views: 0
DOI
10.63947/bvtn.v2i8.6
Published
2026-06-07
Issue Vol. 2 No. 8 (2026): Geriatric Medicine in the Era of Personalization, Technology, and Prevention
Section
Original Research
Categories
Research

Download Article

PDF (Vietnamese)

How to Cite

1.
Thị Mai Hạnh N, Chung H, Võ Công Nguyên Đỗ. DIAGNOSTIC VALUE OF COMPUTED TOMOGRAPHY ANGIOGRAPHY IN THE DIAGNOSIS OF GASTROINTESTINAL HEMORRHAGE. JHA [Internet]. Vietnam; 2026 Jun. 7 [cited 2026 Jun. 18];2(8):42–47. https://tcsuckhoelaohoa.vn/bvtn/article/view/210 doi: 10.63947/bvtn.v2i8.6
Loading citation...
Crossref
Scopus
Google Scholar
Europe PMC

Abstract

Gastrointestinal hemorrhage (GIH) is a common medical-surgical emergency with high morbidity and mortality rates. Rapid and accurate identification of the location and cause of bleeding is essential to guide timely intervention. Computed tomography angiography (CTA) has emerged as a modern, non-invasive imaging method capable of detecting active bleeding with high sensitivity and specificity. This study aimed to describe the CTA imaging characteristics in patients with GIH and evaluate the value of CTA in diagnosing and localizing hemorrhage. A cross-sectional study was conducted at Thong Nhat Hospital, Ho Chi Minh City, from May 2024 to May 2025, involving 31 patients ≥18 years old with suspected GIH who underwent CTA when endoscopy failed and were confirmed by endoscopy, digital subtraction angiography (DSA), or surgery. Data were analyzed using SPSS 20.0, calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Among 31 patients (71% male; mean age 62.5 ± 17.1 years), the most common CTA finding was contrast extravasation in the arterial phase >90 HU (38.7%), of which 50% showed changes in density and 33.3% showed morphological changes in the venous phase. Other findings included perienteric fat stranding (32.3%) and bowel wall enhancement (6.5%). CTA had a sensitivity of 73.9%, specificity of 87.5%, PPV of 94.4%, NPV of 53.9%, and accuracy of 77.4%. The most common bleeding site was the small bowel (27.8%). The main causes were ulceration (22.2%) and GIST tumors (16.7%). CTA is a highly valuable, non-invasive method for diagnosing and localizing GIH, particularly useful when endoscopy fails, with high specificity and good applicability in clinical practice.

References

  1. Choi YJ, Kim KS, Suh GJ, Kwon WY. Diagnostic accuracy and implementation of computed tomography angiography for gastrointestinal
  2. hemorrhage according to clinical severity. Clin Exp Emerg Med. 2016;3(2):69-74. doi: 10.15441/ ceem.15.066.
  3. Vai trò của can thiệp nội mạch trong điều trị xuất huyết tiêu hóa. 26: Tạp chí Y học Thành phố Hồ Chí Minh; 2022. p. 67-72.
  4. Khảo sát tình hình điều trị xuất huyết tiêu hóa trên không do tăng áp tĩnh mạch cửa tại một số bệnh viện lớn. 19: Tạp chí Y học Thành phố Hồ Chí Minh; 2015. p. 74-.
  5. Tỷ lệ tử vong nội viện và các yếu tố liên quan ở bệnh nhân cao tuổi bị xuất huyết tiêu hoá trên do loét dạ dày tá tràng. 550: Tạp chí Y học Việt Nam; 2025.
  6. Nghiên cứu bước đầu kết quả chụp và nút mạch trong điều trị chảy máu tiêu hóa dưới. 52: Nghiên cứu khoa học; 2023.
  7. Nghiên cứu các thời điểm nội soi và kết quả điều trị ở bệnh nhân xuất huyết tiêu hoá do loét dạ dày-tá tràng tại bệnh viện đa khoa trung ương Cần Thơ năm 2022-2023. Tạp chí Y Dược học Cần Thơ; 2023. p. 99-108.
  8. Zhou D-Y, Jiang B, Yang X-S. Advances and applications of enteroscopy for small bowel. World J Gastroenterol. 1997;3(4):205-7. doi: 10.3748/wjg.v3.i4.205.
  9. Zuckerman GR, Prakash C. Acute lower intestinal bleedingPart I: Clinical presentation and diagnosis. Gastrointestinal Endoscopy. 1998;48(6):606-16. doi: 10.1016/S00165107(98)70043-4.
  10. Rockey DC. Lower Gastrointestinal Bleed- ing. Gastroenterology. 2006;130(1):165-71. doi:10.1053/j.gastro.2005.11.042.
  11. Kuo JR, Pasha SF, Leighton JA. The Clini- cian’s Guide to Suspected Small Bowel Bleed- ing. Official journal of the American College of Gastroenterology | ACG. 2019;114(4):591. doi:10.1038/s41395-018-0424-x.
  12. Kuhle WG, Sheiman RG. Detection of Active Colonic Hemorrhage with Use of Helical CT: Findings in a Swine Model1. Radiology. 2003. doi: 10.1148/radiol.2283020756. PubMed intestinal bleeding Part I: Clinical presentation and diagnosis. Gastrointestinal Endoscopy. 1998;48(6):606-16. doi: 10.1016/S00165107(98)70044.
  13. Rockey DC. Lower Gastrointestinal Bleed- ing. Gastroenterology. 2006;130(1):165-71. doi: 10.1053/j.gastro.2005.11.042.
  14. Kuo JR, Pasha SF, Leighton JA. The Clini- cian’s Guide to Suspected Small Bowel Bleed- ing. Official journal of the American College of Gastroenterology | ACG. 2019;114(4):591. doi:10.1038/s41395-018-0424-x.
  15. Kuhle WG, Sheiman RG. Detection of Active Colonic Hemorrhage with Use of Helical CT: Findings in a Swine Model1. Radiology. 2003. doi: 10.1148/radiol.2283020756. PubMed PMID: world.
  16. Guglielmo FF, Wells ML, Bruining DH, Strate LL, Huete Á, Gupta A, et al. Gastrointestinal Bleeding at CT Angiography and CT Enterography: Imaging Atlas and Glossary of Terms. RadioGraphics. 2021;41(6):1632-56. doi: 10.1148/rg.2021210043.
  17. Geffroy Y, Rodallec MH, Boulay-Coletta I, Jullès M-C, Ridereau-Zins C, Zins M. Multidetector CT Angiography in Acute Gastrointestinal Bleeding: Why, When, and How. RadioGraphics. 2011;31(3):E35-E46. doi: 10.1148/rg.313105206.
  18. García-Blázquez V, Vicente-Bártulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J, et al. Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. Eur Radiol. 2013;23(5):1181-90. doi: 10.1007/s00330-012-2721-x.
  19. Lê TD, Thân VS. Can thiệp nội mạch điều trị xuất huyết tiêu hoá cao tại Bệnh viện Hữu nghị Việt Đức. Tạp chí Y học Việt Nam. 2023;526(2). doi: 10.51298/vmj.v526i2.5572
  20. Nguyễn THL, Võ TĐ, Đỗ HTA, Trần TMT, Đỗ ĐC. Giá trị của X quang cắt lớp điện toán trong chẩn đoán xuất huyết tiêu hóa. Tạp chí Y học Thành phố Hồ Chí Minh. 2017;21(1):14.
  21. Yaxley KL, Mulhem A, Godfrey S, Oke JL. The Accuracy of Computed Tomography Angiography Compared With Technetium-99m Labelled Red Blood Cell Scintigraphy for the Diagnosis and Localization of Acute Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis. Curr Probl Diagn Radiol. 2023;52(6):546-59. doi: 10.1067/j.cpradiol.2023.05.004.
  22. Yoon W, Jeong YY, Shin SS, Lim HS, Song SG, Jang NG, et al. Acute massive gastrointes- tinal bleeding: detection and localization with arterial phase multi-detector row helical CT. Radiology. 2006;239(1):160-7. doi: 10.1148/ra- diol.2383050175.
  23. Martí M, Artigas JM, Garzón G, Alvarez-Sala R, Soto JA. Acute lower intestinal bleeding: feasibility and diagnostic performance of CT angiography. Radiology. 2012;262(1):109-16. doi: 10.1148/radiol.11110326.
  24. Gu-mu-yang Z, Hao SUN, Hua-dan XUE, Xiao-guang LI, Zheng-yu JIN. Computed Tomography Signs for Active Severe Gastroin- testinal Bleeding. Acta Academiae Medici- nae Sinicae. 2016;38(3):322-6. doi: 10.3881/j. issn.1000-503X.2016.03.014.
  25. He B, Gong S, Hu C, Fan J, Qian J, Huang S, et al. Obscure gastrointestinal bleeding: bjr.20140229
  26. Shotar E, Soyer P, Barat M, Dautry R, Pocard M, Placé V, et al. Diagnosis of acute overt gastrointestinal bleeding with CT-angiography: Comparison of the diagnostic performance of individual acquisition phases. Diagnostic and Interventional Imaging. 2017;98(12):857-63. doi: 10.1016/j.diii.2017.06.018.
  27. Sun H, Hou X-Y, Xue H-D, Li X-G, Jin Z-Y, Qian J-M, et al. Dual-source dual-energy CT angiography with virtual non-enhanced images and iodine map for active gastrointestinal bleeding: image quality, radiation dose and diagnostic performance. European Journal of Radiology. 2015;84(5):884-91. doi: 10.1016/j. ejrad.2015.01.013.
  28. Pouw ME, Albright JW, Kozhimala MJ, Baird GL, Nguyen VT, Prince EA, et al. Adding non-contrast and delayed phases increases the diagnostic performance of arterial CTA for suspected active lower gastrointestinal bleeding. Eur Radiol. 2022;32(7):4638-46. doi: 10.1007/s00330-022-08559-z.
  29. Nguyễn HVA, Nguyễn AT. Nghiên cứu đặc điểm lâm sàng, cận lâm sàng và xử trí xuất huyết tiêu hóa do giãn tĩnh mạch dạ dày tại Bệnh viện Bạch Mai. Tạp chí Y học Việt Nam. 2023;520(1B). doi: 10.51298/vmj.v520i1B.3901.
  30. Chua AE, Ridley LJ. Diagnostic accuracy of CT angiography in acute gastrointestinal bleeding. Journal of Medical Imaging and Radiation Oncology. 2008;52(4):333-8. doi:10.1111/j.1440-1673.2008.01964.x.
  31. Sengupta N, Kastenberg DM, Bruining DH, Latorre M, Leighton JA, Brook OR, et al. The Role of Imaging for Gastrointestinal Bleeding: Consensus Recommendations From the American College of Gastroenterology and Society of Abdominal Radiology. Official jour- nal of the American College of Gastroenterology | ACG. 2024;119(3):438. doi: 10.14309/ajg.0000000000002631.
  32. Kim J, Kim YH, Lee KH, Lee YJ, Park JH. Diagnostic Performance of CT Angiography in Patients Visiting Emergency Department with Overt Gastrointestinal Bleeding. Korean J Radiol. 2015;16(3):541-9. doi: 10.3348/kjr.2015.16.3.541.
  33. Sengupta N, Kastenberg DM, Bruining DH, Latorre M, Leighton JA, Brook OR, et al. The Role of Imaging for GI Bleeding: ACG and SAR Consensus Recommendations. Radiology. 2024;310(3):e232298. doi: 10.1148/radi- ol.232298.
  34. Sengupta N, Kastenberg DM, Bruining DH, Latorre M, Leighton JA, Brook OR, et al. The Role of Imaging for GI Bleeding: ACG and SAR Consensus Recommendations. Radiology. 2024;310(3):e232298. doi: 10.1148/radiol.232298

License

© 2026 The Author(s). Published by Journal of Health and Aging.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.