Mesenteric duplex scanning: A blinded prospective study

Abstract

Based on retrospective comparisons of duplex scanning with arteriography of the celiac (CA) and superior mesenteric (SMA) arteries in 34 patients, we previously suggested that an SMA peak systolic velocity of 275 cm/sec or greater or no flow signal and a CA PSV of 200 cm/sec or greater or no flow signal were reliable indicators of a 70% or greater angiographic stenosis of the SMA and CA, respectively. We now report the results of a blinded, prospective study in a larger patient group designed to determine the ability of mesenterie duplex scanning to visualize the CA and SMA and to validate our proposed duplex criteria for splanchnic artery stenosis. Methods: During an 18-month period 100 patients admitted to our vascular surgery service for aortography underwent routine mesenteric artery duplex scanning and lateral abdominal aortography regardless of abdominal symptoms. The lateral aortograms were evaluated to determine the presence or absence of a 70% or greater stenosis in the CA or SMA. Duplex-determined peak systolic velocities from the CA and SMA were recorded without knowledge of the angiographic results. Results: Aortography satisfactorily visualized 100% of the CAs and 99% of the SMAs. Of these, 93% of the SMAs and 83% of the CAs were visualized by duplex. According to the above criteria, duplex sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy for detection of a 70% or greater SMA stenosis were 92%, 96%, 80%, 99%, and 96% and for a 70% or greater CA stenosis 87%, 80%, 63%, 94%, and 82%. Conclusions: Mesenteric duplex scanning is feasible in the majority of patients. Prospective evaluation of duplex diagnostic criteria for 70% or greater stenosis indicates that mesenteric duplex scanning is sufficiently accurate to be clinically useful as a screening examination to detect SMA and CA stenosis.

Diagnosis and management of splanchnic ischemia

“…A significant stenosis is characterized by areas of high velocity jets (small streaks of very high, sometimes turbulent flow) within the artery, and overall increased flow velocity. The widely accepted cut-off values, published by Moneta in 1993 [53] . Using these threshold values, the sensitivity and specificity for stenoses > 70% were 89% and 44% for the inspiration CA, 89% and 62% for the expiration CA, 100% and 61% for the inspiration SMA, and 80% and 42% for the expiration SMA.…”

A 41-year-old woman with paroxysmal abdominal pain, weight loss and an epigastric bruit

“…Flow velocity measurement as an additional criterion can be obtained. A 7peak systolic velocity of greater than 200 cm/s has a sensitivity of 75% and a specificity of 89% in detection of a 70% or greater celiac axis stenosis [12,13].…”

Comparison of Noninvasive Imaging Modalities for Stenosis Grading in Mesenteric Arteries

“…However, as Shih et al state [10], we see limitations for MRA due to the lower spatial resolution, longer acquisition times and potential stent-induced artifacts, which may prevent a sufficient stenosis classification. In a former study, Moneta et al demonstrated the feasibility of duplex US in the mesenteric arteries, the celiac trunk and the SMA [14]. For detecting relevant stenosis with a threshold of 70 %, they reported a sensitivity, specificity, and accuracy of 87 %, 80 %, and 82 %, respectively, for the celiac trunk and 92 %, 96 %, and 96 %, respectively, for the SMA.…”

“…1). As DSA allows only catheter based angiography and is thus limited to vascular diagnoses, all tested noninvasive modalities may provide additional information regarding tissue and organs surrounding the mesenteric arteries and thus expand the diagnostic field [6-8, [14][15][16][17]. Especially in patients with acute mesenteric ischemia, CTA is considered the first-line imaging method [16][17][18][19][20][21][22].…”