Abstract
Gastrointestinal bleeding is a common cause for hospital admissions and is an important cause of morbidity and mortality. Although endoscopy is accepted as the standard initial diagnostic modality for the evaluation of gastrointestinal bleeding, multiphasic computed tomography (CT) imaging has become an alternative diagnostic tool. Dual-energy CT with post-processing techniques may have additional advantages over single-energy computed tomography in evaluation of gastrointestinal bleeding. In this article, we discuss the role of dual-energy CT in the evaluation of gastrointestinal bleeding with potential advantages over conventional CT and limitations.
Similar content being viewed by others
References
Laing CJ, Tobias T, Rosenblum DI, Banker WL, Tseng L, Tamarkin SW (2007) Acute gastrointestinal bleeding: emerging role of multidetector CT angiography and review of current imaging techniques. Radiographics 27 (4):1055-1070. https://doi.org/10.1148/rg.274065095
Artigas JM, Marti M, Soto JA, Esteban H, Pinilla I, Guillen E (2013) Multidetector CT angiography for acute gastrointestinal bleeding: technique and findings. Radiographics 33 (5):1453-1470. https://doi.org/10.1148/rg.335125072
Morrison TC, Wells M, Fidler JL, Soto JA (2018) Imaging Workup of Acute and Occult Lower Gastrointestinal Bleeding. Radiologic clinics of North America 56 (5):791-804. https://doi.org/10.1016/j.rcl.2018.04.009
Nelms DW, Pelaez CA (2018) The Acute Upper Gastrointestinal Bleed. The Surgical clinics of North America 98 (5):1047-1057. https://doi.org/10.1016/j.suc.2018.05.004
Kim G, Soto JA, Morrison T (2018) Radiologic Assessment of Gastrointestinal Bleeding. Gastroenterology clinics of North America 47 (3):501-514. https://doi.org/10.1016/j.gtc.2018.04.003
Wells ML, Hansel SL, Bruining DH, Fletcher JG, Froemming AT, Barlow JM, Fidler JL (2018) CT for Evaluation of Acute Gastrointestinal Bleeding. Radiographics 38 (4):1089-1107. https://doi.org/10.1148/rg.2018170138
Feinman M, Haut ER (2014) Upper gastrointestinal bleeding. The Surgical clinics of North America 94 (1):43-53. https://doi.org/10.1016/j.suc.2013.10.004
Hara AK, Leighton JA, Sharma VK, Heigh RI, Fleischer DE (2005) Imaging of small bowel disease: comparison of capsule endoscopy, standard endoscopy, barium examination, and CT. Radiographics 25 (3):697-711; discussion 711-698. https://doi.org/10.1148/rg.253045134
Expert Panels on Vascular I, Gastrointestinal I, Singh-Bhinder N, Kim DH, Holly BP, Johnson PT, Hanley M, Carucci LR, Cash BD, Chandra A, Gage KL, Lambert DL, Levy AD, Oliva IB, Peterson CM, Strax R, Rybicki FJ, Dill KE (2017) ACR Appropriateness Criteria((R)) Nonvariceal Upper Gastrointestinal Bleeding. J Am Coll Radiol 14 (5S):S177-S188. https://doi.org/10.1016/j.jacr.2017.02.038
Quiroga Gomez S, Perez Lafuente M, Abu-Suboh Abadia M, Castell Conesa J (2011) [Gastrointestinal bleeding: the role of radiology]. Radiologia 53 (5):406-420. https://doi.org/10.1016/j.rx.2011.03.013
Garcia-Blazquez V, Vicente-Bartulos A, Olavarria-Delgado A, Plana MN, van der Winden D, Zamora J (2013) Accuracy of CT angiography in the diagnosis of acute gastrointestinal bleeding: systematic review and meta-analysis. European radiology 23 (5):1181-1190. https://doi.org/10.1007/s00330-012-2721-x
Yoon W, Jeong YY, Shin SS, Lim HS, Song SG, Jang NG, Kim JK, Kang HK (2006) Acute massive gastrointestinal bleeding: detection and localization with arterial phase multi-detector row helical CT. Radiology 239 (1):160-167. https://doi.org/10.1148/radiol.2383050175
Elsayes KM, Al-Hawary MM, Jagdish J, Ganesh HS, Platt JF (2010) CT enterography: principles, trends, and interpretation of findings. Radiographics : a review publication of the Radiological Society of North America, Inc 30 (7):1955-1970. https://doi.org/10.1148/rg.307105052
Murray N, Darras KE, Walstra FE, Mohammed MF, McLaughlin PD, Nicolaou S (2019) Dual-Energy CT in Evaluation of the Acute Abdomen. Radiographics : a review publication of the Radiological Society of North America, Inc 39 (1):264-286. https://doi.org/10.1148/rg.2019180087
Aran S, Shaqdan KW, Abujudeh HH (2014) Dual-energy computed tomography (DECT) in emergency radiology: basic principles, techniques, and limitations. Emergency radiology 21 (4):391-405. https://doi.org/10.1007/s10140-014-1208-2
Marin D, Boll DT, Mileto A, Nelson RC (2014) State of the art: dual-energy CT of the abdomen. Radiology 271 (2):327-342. https://doi.org/10.1148/radiol.14131480
Heye T, Nelson RC, Ho LM, Marin D, Boll DT (2012) Dual-energy CT applications in the abdomen. AJR American journal of roentgenology 199 (5 Suppl):S64-70. https://doi.org/10.2214/ajr.12.9196
Yeh BM, Obmann MM, Westphalen AC, Ohliger MA, Yee J, Sun Y, Wang ZJ (2018) Dual Energy Computed Tomography Scans of the Bowel: Benefits, Pitfalls, and Future Directions. Radiologic clinics of North America 56 (5):805-819. https://doi.org/10.1016/j.rcl.2018.05.002
Shaqdan KW, Parakh A, Kambadakone AR, Sahani DV (2018) Role of dual energy CT to improve diagnosis of non-traumatic abdominal vascular emergencies. Abdominal radiology (New York). https://doi.org/10.1007/s00261-018-1741-7
Fulwadhva UP, Wortman JR, Sodickson AD (2016) Use of Dual-Energy CT and Iodine Maps in Evaluation of Bowel Disease. Radiographics : a review publication of the Radiological Society of North America, Inc 36 (2):393-406. https://doi.org/10.1148/rg.2016150151
Agrawal MD, Pinho DF, Kulkarni NM, Hahn PF, Guimaraes AR, Sahani DV (2014) Oncologic applications of dual-energy CT in the abdomen. Radiographics : a review publication of the Radiological Society of North America, Inc 34 (3):589-612. https://doi.org/10.1148/rg.343135041
Yu L, Leng S, McCollough CH (2012) Dual-energy CT-based monochromatic imaging. AJR American journal of roentgenology 199 (5 Suppl):S9-s15. https://doi.org/10.2214/ajr.12.9121
Sugawara H, Suzuki S, Katada Y, Ishikawa T, Fukui R, Yamamoto Y, Abe O (2018) Comparison of full-iodine conventional CT and half-iodine virtual monochromatic imaging: advantages and disadvantages. European radiology. https://doi.org/10.1007/s00330-018-5724-4
Patino M, Parakh A, Lo GC, Agrawal M, Kambadakone AR, Oliveira GR, Sahani DV (2019) Virtual Monochromatic Dual-Energy Aortoiliac CT Angiography With Reduced Iodine Dose: A Prospective Randomized Study. AJR American journal of roentgenology 212 (2):467-474. https://doi.org/10.2214/ajr.18.19935
Machida H, Tanaka I, Fukui R, Shen Y, Ishikawa T, Tate E, Ueno E (2016) Dual-Energy Spectral CT: Various Clinical Vascular Applications. Radiographics 36 (4):1215-1232. https://doi.org/10.1148/rg.2016150185
Darras KE, McLaughlin PD, Kang H, Black B, Walshe T, Chang SD, Harris AC, Nicolaou S (2016) Virtual monoenergetic reconstruction of contrast-enhanced dual energy CT at 70 keV maximizes mural enhancement in acute small bowel obstruction. European journal of radiology 85 (5):950-956. https://doi.org/10.1016/j.ejrad.2016.02.019
Lenga L, Czwikla R, Wichmann JL, Leithner D, Albrecht MH, Booz C, Arendt CT, Yel I, D’Angelo T, Vogl TJ, Martin SS (2018) Dual-energy CT in patients with colorectal cancer: Improved assessment of hypoattenuating liver metastases using noise-optimized virtual monoenergetic imaging. European journal of radiology 106:184-191. https://doi.org/10.1016/j.ejrad.2018.07.027
Martin SS, Pfeifer S, Wichmann JL, Albrecht MH, Leithner D, Lenga L, Scholtz JE, Vogl TJ, Bodelle B (2017) Noise-optimized virtual monoenergetic dual-energy computed tomography: optimization of kiloelectron volt settings in patients with gastrointestinal stromal tumors. Abdominal radiology (New York) 42 (3):718-726. https://doi.org/10.1007/s00261-016-1011-5
Martin SS, Wichmann JL, Pfeifer S, Leithner D, Lenga L, Reynolds MA, D’Angelo T, Hammerstingl R, Gruber-Rouh T, Vogl TJ, Albrecht MH (2017) Impact of noise-optimized virtual monoenergetic dual-energy computed tomography on image quality in patients with renal cell carcinoma. European journal of radiology 97:1-7. https://doi.org/10.1016/j.ejrad.2017.10.008
Martin SS, Wichmann JL, Scholtz JE, Leithner D, D’Angelo T, Weyer H, Booz C, Lenga L, Vogl TJ, Albrecht MH (2017) Noise-Optimized Virtual Monoenergetic Dual-Energy CT Improves Diagnostic Accuracy for the Detection of Active Arterial Bleeding of the Abdomen. Journal of vascular and interventional radiology : JVIR 28 (9):1257-1266. https://doi.org/10.1016/j.jvir.2017.06.011
Patel BN, Alexander L, Allen B, Berland L, Borhani A, Mileto A, Moreno C, Morgan D, Sahani D, Shuman W, Tamm E, Tublin M, Yeh B, Marin D (2017) Dual-energy CT workflow: multi-institutional consensus on standardization of abdominopelvic MDCT protocols. Abdominal radiology (New York) 42 (3):676-687. https://doi.org/10.1007/s00261-016-0966-6
Ilangovan R, Burling D, George A, Gupta A, Marshall M, Taylor SA (2012) CT enterography: review of technique and practical tips. Br J Radiol 85 (1015):876-886. https://doi.org/10.1259/bjr/27973476
Im AL, Lee YH, Bang DH, Yoon KH, Park SH (2013) Dual energy CT in patients with acute abdomen; is it possible for virtual non-enhanced images to replace true non-enhanced images? Emerg Radiol 20 (6):475-483. https://doi.org/10.1007/s10140-013-1141-9
Uhrig M, Simons D, Kachelriess M, Pisana F, Kuchenbecker S, Schlemmer HP (2016) Advanced abdominal imaging with dual energy CT is feasible without increasing radiation dose. Cancer Imaging 16 (1):15. https://doi.org/10.1186/s40644-016-0073-5
Wichmann JL, Hardie AD, Schoepf UJ, Felmly LM, Perry JD, Varga-Szemes A, Mangold S, Caruso D, Canstein C, Vogl TJ, De Cecco CN (2017) Single- and dual-energy CT of the abdomen: comparison of radiation dose and image quality of 2nd and 3rd generation dual-source CT. Eur Radiol 27 (2):642-650. https://doi.org/10.1007/s00330-016-4383-6
Purysko AS, Primak AN, Baker ME, Obuchowski NA, Remer EM, John B, Herts BR (2014) Comparison of radiation dose and image quality from single-energy and dual-energy CT examinations in the same patients screened for hepatocellular carcinoma. Clin Radiol 69 (12):e538-544. https://doi.org/10.1016/j.crad.2014.08.021
Mongan J, Rathnayake S, Fu Y, Gao DW, Yeh BM (2013) Extravasated contrast material in penetrating abdominopelvic trauma: dual-contrast dual-energy CT for improved diagnosis–preliminary results in an animal model. Radiology 268 (3):738-742. https://doi.org/10.1148/radiol.13121267
Sun H, Hou XY, Xue HD, Li XG, Jin ZY, Qian JM, Yu JC, Zhu HD (2015) 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 84 (5):884-891. https://doi.org/10.1016/j.ejrad.2015.01.013
Schatz RA, Rockey DC (2017) Gastrointestinal Bleeding Due to Gastrointestinal Tract Malignancy: Natural History, Management, and Outcomes. Dig Dis Sci 62 (2):491-501. https://doi.org/10.1007/s10620-016-4368-y
He J, Ma X, Wang Q, Fan J, Sun Z (2014) Spectral CT demonstration of the superior mesenteric artery: comparison of monochromatic and polychromatic imaging. Acad Radiol 21 (3):364-368. https://doi.org/10.1016/j.acra.2013.11.004
Balthazar EJ (1991) CT of the gastrointestinal tract: principles and interpretation. AJR American journal of roentgenology 156 (1):23-32. https://doi.org/10.2214/ajr.156.1.1898566
Morgan DE (2018) The Role of Dual-Energy Computed Tomography in Assessment of Abdominal Oncology and Beyond. Radiologic clinics of North America 56 (4):565-585. https://doi.org/10.1016/j.rcl.2018.03.005
Boellaard TN, Henneman OD, Streekstra GJ, Venema HW, Nio CY, van Dorth-Rombouts MC, Stoker J (2013) The feasibility of colorectal cancer detection using dual-energy computed tomography with iodine mapping. Clinical radiology 68 (8):799-806. https://doi.org/10.1016/j.crad.2013.03.005
Potretzke TA, Brace CL, Lubner MG, Sampson LA, Willey BJ, Lee FT, Jr. (2015) Early small-bowel ischemia: dual-energy CT improves conspicuity compared with conventional CT in a swine model. Radiology 275 (1):119-126. https://doi.org/10.1148/radiol.14140875
Lee SM, Kim SH, Ahn SJ, Kang HJ, Kang JH, Han JK (2018) Virtual monoenergetic dual-layer, dual-energy CT enterography: optimization of keV settings and its added value for Crohn’s disease. European radiology 28 (6):2525-2534. https://doi.org/10.1007/s00330-017-5215-z
De Kock I, Delrue L, Lecluyse C, Hindryckx P, De Vos M, Villeirs G (2018) Feasibility study using iodine quantification on dual-energy CT enterography to distinguish normal small bowel from active inflammatory Crohn’s disease. Acta radiologica (Stockholm, Sweden : 1987):284185118799508. https://doi.org/10.1177/0284185118799508
Wortman JR, Sodickson AD (2018) Pearls, Pitfalls, and Problems in Dual-Energy Computed Tomography Imaging of the Body. Radiologic clinics of North America 56 (4):625-640. https://doi.org/10.1016/j.rcl.2018.03.007
Kim YJ, Cha JG, Kim H, Yi JS, Kim HJ (2019) Dual-Energy and Iterative Metal Artifact Reduction for Reducing Artifacts Due to Metallic Hardware: A Loosening Hip Phantom Study. AJR American journal of roentgenology:1-6. https://doi.org/10.2214/ajr.18.20413
Kaza RK, Ananthakrishnan L, Kambadakone A, Platt JF (2017) Update of Dual-Energy CT Applications in the Genitourinary Tract. AJR Am J Roentgenol 208 (6):1185-1192. https://doi.org/10.2214/ajr.16.17742
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Authors Tugce Agirlar Trabzonlu and Amirhossein Mozaffary have received educational grants from Siemens Healthineers. Other authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
CME activity This article has been selected as the CME activity for the current month. Please visit https://ce.mayo.edu/node/89889 and follow the instructions to complete this CME activity.
Rights and permissions
About this article
Cite this article
Trabzonlu, T.A., Mozaffary, A., Kim, D. et al. Dual-energy CT evaluation of gastrointestinal bleeding. Abdom Radiol 45, 1–14 (2020). https://doi.org/10.1007/s00261-019-02226-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-019-02226-6