Mesenteric and celiac duplex scanning: a validation study

Area of Science:

• Vascular Surgery
• Diagnostic Imaging
• Medical Ultrasound

Background:

• Mesenteric artery stenosis, particularly in the superior mesenteric artery (SMA) and celiac artery (CA), can lead to chronic mesenteric ischemia.
• Established duplex ultrasound criteria exist for diagnosing SMA stenosis, but validation in a larger cohort is necessary.
• Accurate non-invasive diagnosis of mesenteric artery stenosis is crucial for timely intervention.

Purpose of the Study:

• To validate previously established duplex ultrasound criteria for diagnosing greater than or equal to 50% stenosis of the SMA and CA.
• To compare the accuracy of duplex ultrasound findings with arteriography in a cohort of patients with suspected chronic mesenteric ischemia.

Main Methods:

• A retrospective analysis of 243 mesenteric duplex scans was performed.
• Angiographic confirmation was available for 46 patients, with SMA and CA diameters measured by observers blinded to duplex results.
• Receiver operator characteristic (ROC) curve analysis was used to identify optimal velocity thresholds for stenosis detection.

Main Results:

• Duplex ultrasound demonstrated high technical adequacy for SMA (98%) and CA (96%) assessment.
• For SMA stenosis, end-diastolic velocity (EDV) > or =45 cm/sec showed 91% overall accuracy, while peak systolic velocity (PSV) > or =300 cm/sec had lower accuracy (81%).
• Retrograde common hepatic artery flow was 100% predictive of severe CA stenosis or occlusion. For CA stenosis, EDV > or =55 cm/sec or no flow signal yielded 95% accuracy.

Conclusions:

• Duplex ultrasound velocity criteria are accurate for identifying mesenteric occlusive disease.
• Retrograde common hepatic artery flow is a reliable indicator of severe CA stenosis or occlusion.
• Duplex ultrasound can also identify mesenteric anatomic variants that may affect interpretation.