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Updated: Jun 28, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
[Duplex US evaluation of mesenteric vessels in acute abdomen. Prospective study on 325 patients]
A Baccoli1, A R Manconi, P Sau
1Azienda USL 5, Oristano, U.O. Chirurgia Generale e d'Urgenza, Punto di Guardia Medica, Presidio Ospedaliero San Martino, Oristano, Università degli Studi di Cagliari, Docente di Bioetica.
Background:
Acute Mesenteric Insufficiency (AMI) is a surgical emergency with a difficult methodological approach. Its high mortality is mainly due to delay in the correct diagnosis. In turn this is due to the lack of specificity of the clinical presentation and of the laboratory data and abdominal radiographic findings, especially in the early-middle phase.
Purpose:
To evaluate the positive predictive value (PPV) and negative predictive value (NPV) of Duplex Ultrasound (DU) of mesenteric vessels in the diagnosis of acute mesenteric ischaemia.
Patients And Methods:
325 patients were prospective analyzed with Duplex US (Aloka ssd 1700); 120 with acute abdomen (group A); 120 healthy subjects without abdomen preparation (group B); 85 healthy subjects with abdomen preparation (group C). We considered the B mode visualization, the vessel extension and diameter, the colour signal capture (enhancement), the velocitograms with systolic peak velocity and medium diastolic velocity.
Results:
In 32 patients with high suspect of AMI we founded 21 really negative results, 3 wrong positive results, 5 really positive results, 3 false negative results. The PPV and NPV were respectively 0.62 and 0.87.
Conclusions:
The Duplex Us is more useful rather exclude than confirm AMI.
Insights
Duplex Ultrasound (DU) shows moderate accuracy in diagnosing acute mesenteric insufficiency (AMI). While it has a good negative predictive value (NPV) of 0.87, its positive predictive value (PPV) of 0.62 suggests it is more useful for ruling out AMI.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Gastroenterology
Background:
- Acute Mesenteric Insufficiency (AMI) is a critical surgical emergency.
- Delayed diagnosis, due to non-specific clinical and laboratory findings, contributes to high mortality.
- Early-to-mid-stage AMI diagnosis is particularly challenging.
Purpose of the Study:
- To determine the diagnostic accuracy of Duplex Ultrasound (DU) for acute mesenteric ischemia.
- Evaluate the positive predictive value (PPV) and negative predictive value (NPV) of DU in diagnosing AMI.
Main Methods:
- Prospective analysis of 325 patients using Duplex Ultrasound.
- Included 120 patients with acute abdomen, 120 healthy controls (no preparation), and 85 healthy controls (with preparation).
- Assessed B-mode visualization, vessel characteristics, color signal enhancement, and Doppler velocimetry.
Main Results:
- In 32 patients suspected of AMI, DU yielded 21 true negatives, 3 false positives, 5 true positives, and 3 false negatives.
- The calculated Positive Predictive Value (PPV) was 0.62.
- The calculated Negative Predictive Value (NPV) was 0.87.
Conclusions:
- Duplex Ultrasound demonstrates a higher utility in excluding acute mesenteric insufficiency.
- The diagnostic performance suggests DU is more effective for ruling out AMI than confirming it.
