Tc-99m sulfur colloid and Tc-99m tagged red blood cell methods are comparable for detecting lower gastrointestinal bleeding in clinical practice

Purpose: The objective of this study was to determine whether the Tc-99m red blood cells (Tc-99m RBC) method has a true advantage over the Tc-99m sulfur colloid (Tc-99m SC) technique in a busy clinical practice for detecting and localizing lower gastrointestinal bleeding sites. Methods: Three hundred fifty-nine consecutive gastrointestinal bleeding studies performed during the past 4 years were reviewed retrospectively. One hundred ninety-three scans were obtained with Tc-99m SC (scan duration, 30 minutes) and 138 studies were performed after the administration of Tc-99m RBC (scan duration, I hour). In addition, 28 examinations with Tc-99m SC were followed immediately by Tc-99m RBC scans for a duration of several hours. The results of the two methods were analyzed and the performance of the two techniques was compared. Results: Among 193 scans performed using the Tc-99m SC method, 47 (24.4%) successfully identified the location of the bleeding site, whereas in 138 scans performed using Tc-99m RBC, 38 (27.5%) were successful for this purpose. In the remaining 28 scans in which the Tc-99m SC scan was followed by the Tc-99m RBC study, only 4 (14.3%) positive bleeding sites were identified after a prolonged imaging period. Discussion:The theoretical advantages of the Tc-99m RBC technique compared with the Tc-99m SC method cannot be substantiated by this study. Our findings suggest that the efficacy of these two methods is nearly equal at a practical level. Conclusion: The simpler and cost-effective Tc-99m SC method is as efficient as the Tc-99m RBC method when the scanning time is limited to I hour and optimal imaging and interpretation schemes are used.