Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Radiologic Diagnosis of Gastrointestinal Bleeding

위장관 출혈의 영상의학적 진단법

  • Se Hyung Kim (Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine)
  • 김세형 (서울대학교 의과대학 서울대학교병원 영상의학과)
  • Received : 2022.12.23
  • Accepted : 2023.02.19
  • Published : 2023.05.01
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Abstract

Gastrointestinal (GI) bleeding is not a single disease but a symptom and clinical manifestation of a broad spectrum of conditions in the GI tract. According to its clinical presentation, GI bleeding can be classified into overt, occult, and obscure types. Additionally, it can be divided into upper and lower GI bleeding based on the Treitz ligament. Variable disease entities, including vascular lesions, polyps, neoplasms, inflammation such as Crohn's disease, and heterotopic pancreatic or gastric tissue, can cause GI bleeding. CT and conventional angiographies and nuclear scintigraphy are all radiologic imaging modalities that can be used to evaluate overt bleeding. For the work-up of occult GI bleeding, CT enterography (CTE) can be the first imaging modality. For CTE, an adequate bowel distention is critical for obtaining acceptable diagnostic performance as well as minimizing false positives and negatives. Meckel's scintigraphy can be complementarily useful in cases where the diagnosis of CTE is suboptimal. For the evaluation of obscured GI bleeding, various imaging modalities can be used based on clinical status and providers' preferences.

위장관 출혈은 단일 질환이 아니라 광범위한 위장 질환의 증상 및 임상적 발현이다. 임상적 양상에 따라 명백한 출혈, 잠재 출혈, 원인 불명 출혈로 나눌 수 있으며, 출혈 위치에 따라 Treiz 인대를 기준으로 상부 또는 하부 위장관 출혈로 분류할 수 있다. 혈관 질환, 용종, 종양, 크론병, 이소성 췌장 및 이소성 위조직 등 다양한 질환이 위장관 출혈을 일으킬 수 있다. 명백한 출혈을 위한 영상 검사기법은 CT 혈관조영술, 고식적 혈관조영술 및 핵의학적 검사 등이 사용된다. 잠재 위장관 출혈을 평가하기 위한 영상검사로는 CT 소장조영술이 주로 사용되며, 위장관을 적절히 팽창해서 영상을 획득해야 위음성 혹은 위양성을 최소화하여 진단능을 높일 수 있다. CT 소장조영술에서 진단이 확실하지 않은 경우, Meckel scan이 보완적으로 사용될 수 있다. 원인 불명 위장관 출혈에 대한 검사는 임상 양상과 임상의 혹은 영상의학과 의사의 선호도에 따라 다양한 검사가 시행될 수 있으며, 이에 대한 추가적인 연구가 필요하다.

Keywords

Acknowledgement

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2021R1F1A1046393).

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