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Related Experiment Videos

Mesenteric and celiac duplex scanning: a validation study

R M Zwolak1, M F Fillinger, D B Walsh

  • 1Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756, USA.

Journal of Vascular Surgery
|July 4, 1998
PubMed
Summary
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Duplex ultrasound accurately identifies superior mesenteric artery (SMA) and celiac artery (CA) stenosis. Retrograde common hepatic artery flow is highly predictive of severe CA stenosis, and duplex can detect mesenteric anatomic variants.

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.

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  • 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.