What is the role of nuclear medicine scanning in the workup of upper gastrointestinal bleeding (UGIB)?

Updated: Sep 01, 2021
  • Author: Bennie Ray Upchurch, III, MD, FACP, AGAF, FACG, FASGE; Chief Editor: BS Anand, MD  more...
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Nuclear medicine scans may be useful in determining the area of active hemorrhage. Radionuclide imaging for gastrointestinal (GI) bleeding is generally performed with technetium-99m (99mTc)-tagged red blood cells, with an initial injection of radiotracer and subsequent gamma camera imaging. GI bleeding can be identified with visualization of radiotracer activity outside of normal areas of blood pool, which either focally intensifies or moves over time in an antegrade or retrograde manner. In addition, radionuclide studies are highly sensitive: They can detect rates of bleeding as low as 0.05–0.1 mL/minute as well as detect arterial and venous hemorrhages. [62]

However, this imaging modality has a prolonged imaging time and is thereforenot ideal for clinically unstable patients. Radionuclide scans also frequently fail to precisely anatomically localize the site of active bleeding. [62] Nonetheless, radionuclide scanning maintains some appeal as a very noninvasive strategy in evaluating GI bleeding. However, the 2010 American College of Radiology (ACR) criteria state that 99mTc-labeled erythrocyte scans are of limited value in diagnosing upper GI bleeding (UGIB), but continue to be useful in certain cases of obscure UGIB. [61]

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