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Adding non-contrast and delayed phases increases the diagnostic performance of arterial CTA for suspected active lower gastrointestinal bleeding

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

When assessing for lower gastrointestinal bleed (LGIB) using CTA, many advocate for acquiring non-contrast and delayed phases in addition to an arterial phase to improve diagnostic performance though the potential benefit of this approach has not been fully characterized. We evaluate diagnostic accuracy among radiologists when using single-phase, biphasic, and triphasic CTA in active LGIB detection.

Method and materials

A random experimental block design was used where 3 blinded radiologists specialty trained in interventional radiology retrospectively interpreted 96 CTA examinations completed between Oct 2012 and Oct 2017 using (1) arterial only, (2) arterial/non-contrast, and (3) arterial/non-contrast/delayed phase configurations. Confirmed positive and negative LGIB studies were matched, balanced, and randomly ordered. Sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive and negative predictive values, and time to identify the presence/absence of active bleeding were examined using generalized estimating equations (GEE) with sandwich estimation assuming a binary distribution to estimate relative benefit of diagnostic performance between phase configurations.

Results

Specificity increased with additional contrast phases (arterial 72.2; arterial/non-contrast 86.1; arterial/non-contrast/delayed 95.1; p < 0.001) without changes in sensitivity (arterial 77.1; arterial/non-contrast 70.2; arterial/non-contrast/delayed 73.1; p = 0.11) or mean time required to identify bleeding per study (s, arterial 34.8; arterial/non-contrast 33.1; arterial/non-contrast/delayed 36.0; p = 0.99). Overall agreement among readers (Kappa) similarly increased (arterial 0.47; arterial/non-contrast 0.65; arterial/non-contrast/delayed 0.79).

Conclusion

The addition of non-contrast and delayed phases to arterial phase CTA increased specificity and inter-reader agreement for the detection of lower gastrointestinal bleeding without increasing reading times.

Key Points

• A triphasic CTA including non-contrast, arterial, and delayed phase has higher specificity for the detection of lower gastrointestinal bleeding than arterial-phase-only protocols.

• Inter-reader agreement increases with additional contrast phases relative to single-phase CTA.

• Increasing the number of contrast phases did not increase reading times.

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Abbreviations

GEE :

Generalized estimating equations

LGIB :

Lower gastrointestinal bleeding

LR :

Likelihood ratio

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Diagnostic Imaging, Rhode Island Hospital/Brown University, Rhode Island Hospital, 593 Eddy St., Providence, RI, 02903, USA

    Matthew E. Pouw, Grayson L. Baird, Van T. Nguyen, Ethan A. Prince, Albert A. Scappaticci & Sun H. Ahn

  2. Department of Radiology, University of Michigan, Ann Arbor, MI, USA

    Joseph W. Albright

  3. The Warren Alpert Medical School of Brown University, Providence, RI, USA

    Meagan J. Kozhimala

Authors
  1. Matthew E. Pouw
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  2. Joseph W. Albright
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  3. Meagan J. Kozhimala
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  4. Grayson L. Baird
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  5. Van T. Nguyen
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  6. Ethan A. Prince
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  7. Albert A. Scappaticci
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  8. Sun H. Ahn
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Corresponding author

Correspondence to Matthew E. Pouw.

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Guarantor

The scientific guarantor of this publication is Matthew Pouw, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Grayson Baird, PhD, has significant statistical expertise and kindly provided statistical advice for this manuscript.

Informed consent

Verbal consent was obtained from each participating radiologist and informed consent from patients on whom CTA examinations were obtained was waived by the Institutional Review Board given the retrospective nature of the review.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• experimental

• performed at one institution

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Pouw, M.E., Albright, J.W., Kozhimala, M.J. et al. Adding non-contrast and delayed phases increases the diagnostic performance of arterial CTA for suspected active lower gastrointestinal bleeding. Eur Radiol 32, 4638–4646 (2022). https://doi.org/10.1007/s00330-022-08559-z

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  • DOI: https://doi.org/10.1007/s00330-022-08559-z

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