Comparison of diagnostic value of technetium 99m-labeled red blood cell computed single photon emission computed tomography/computed tomography (99mTc-RBC SPECT/CT) and contrast-enhanced multidetector computed tomography (MDCT) for small bowel bleeding: a retrospective study.

ABSTRACT

Background: Although small bowel bleeding is relatively rare, it is a potentially fatal disease, and its diagnosis still faces challenges. Technetium 99m-labeled red blood cell computed single photon emission computed tomography/computed tomography (99mTc-RBC SPECT/CT) and contrast-enhanced multidetector computed tomography (MDCT) are common imaging methods for diagnosing small bowel bleeding, but there have been no studies comparing their diagnostic efficacy for this purpose. This study aims to compare the diagnostic value of 99mTc-RBC SPECT/CT and contrast-enhanced MDCT for small bowel bleeding. Methods: A total of 44 patients (30 males and 14 females, median age of 64 years) definitively diagnosed with small bowel bleeding and 15 non-small bowel bleeding patients (8 males and 7 females, median age of 66 years) were consecutively included in this study. All patients underwent 99mTc-RBC SPECT/CT and contrast-enhanced MDCT examinations at Beijing Friendship Hospital of Capital Medical University between January 2020 to September 2023. The definitive diagnosis had been made through surgery or colonoscopy, or through patient history, patient management, and clinical follow-up. We collected clinical data of the participants. 99mTc-RBC SPECT/CT and contrast-enhanced MDCT were reviewed in a blinded fashion for accuracy of detection of active bleeding as well as the active small bowel bleeding location. Results: Among the 59 patients, the accuracy, sensitivity, and specificity of 99mTc-RBC SPECT were 27.3%, 93.3%, and 92.3%; for 99mTc-RBC SPECT/CT they were 76.3%, 40.5%, and 93.3%; whereas for contrast-enhanced MDCT they were 45.8%, 27.3%, and 100%, respectively. The diagnostic accuracy of 99mTc-RBC SPECT/CT for jejunal and ileal bleeding was high, at 100% and 86.4%, respectively. Meanwhile, 99mTc-RBC SPECT/CT had a higher accuracy in diagnosing more causes of small bowel bleeding. In 59 patients, the combination of 99mTc-RBC SPECT/CT and contrast-enhanced MDCT accurately diagnosed small bowel bleeding and provided precise localization in 50 patients, resulting in the accuracy, sensitivity, and specificity of 84.7%, 79.5%, and 100.0%, respectively. Conclusions: 99mTc-RBC SPECT/CT has high diagnostic value in diagnosing small bowel bleeding and is superior to 99mTc-RBC SPECT and contrast-enhanced MDCT. The combination of 99mTc-RBC SPECT/CT and contrast-enhanced MDCT can further improve the diagnostic accuracy of diagnosis, and can accurately guide the diagnosis and treatment of small bowel bleeding.