T R Harward1, S Smith, J M Seeger. 1. Section of Vascular Surgery, University of Florida College of Medicine, Gainesville.
Abstract
PURPOSE: Detection of mesenteric arterial insufficiency is clinically difficult, and diagnosis frequently requires arteriography. Advances in duplex scanning make this an ideal technique to noninvasively screen patients for chronic mesenteric arterial occlusive disease. However, the accuracy of mesenteric duplex scanning compared with arteriography remains unclear. This study will clearly define the accuracy of abdominal duplex scanning for detection of mesenteric arterial insufficiency. METHODS: The mesenteric duplex scans of 38 patients obtained over a 4-year period were reviewed and compared with lateral aortograms to clarify this issue. Optimal peak systolic frequency (PSF) for predicting less than 50% or 50% or greater stenoses of the superior mesenteric artery (SMA) and celiac axis (CA) were determined from receiver-operating characteristic curves. RESULTS: In the SMA a PSF of 4.5 kHz was 96% sensitive (24/25), 92% specific (12/13), and 95% accurate (36/38) at predicting stenoses less than 50% or 50% or greater. For arteries with stenoses 50% to 99%, regression analysis demonstrated excellent linear correlation between percent stenosis and PSF (r = 0.89). In the CA a PSF of 4.0 kHz had a sensitivity of 100% (30/30), a specificity of 88% (7/8), and an accuracy of 97% (37/38). Again, for arteries with stenoses 50% to 99%, an excellent linear correlation existed between PSF and percent stenosis (r = 0.86). All total arterial occlusions (14) were correctly identified. In all, mesenteric arterial duplex scanning was 96% accurate for predicting SMA and CA stenoses/occlusions. CONCLUSIONS: Abdominal duplex scanning is a noninvasive technique that accurately detects total occlusions and objectively quantitates SMA and CA arterial stenoses.
PURPOSE: Detection of mesenteric arterial insufficiency is clinically difficult, and diagnosis frequently requires arteriography. Advances in duplex scanning make this an ideal technique to noninvasively screen patients for chronic mesenteric arterial occlusive disease. However, the accuracy of mesenteric duplex scanning compared with arteriography remains unclear. This study will clearly define the accuracy of abdominal duplex scanning for detection of mesenteric arterial insufficiency. METHODS: The mesenteric duplex scans of 38 patients obtained over a 4-year period were reviewed and compared with lateral aortograms to clarify this issue. Optimal peak systolic frequency (PSF) for predicting less than 50% or 50% or greater stenoses of the superior mesenteric artery (SMA) and celiac axis (CA) were determined from receiver-operating characteristic curves. RESULTS: In the SMA a PSF of 4.5 kHz was 96% sensitive (24/25), 92% specific (12/13), and 95% accurate (36/38) at predicting stenoses less than 50% or 50% or greater. For arteries with stenoses 50% to 99%, regression analysis demonstrated excellent linear correlation between percent stenosis and PSF (r = 0.89). In the CA a PSF of 4.0 kHz had a sensitivity of 100% (30/30), a specificity of 88% (7/8), and an accuracy of 97% (37/38). Again, for arteries with stenoses 50% to 99%, an excellent linear correlation existed between PSF and percent stenosis (r = 0.86). All total arterial occlusions (14) were correctly identified. In all, mesenteric arterial duplex scanning was 96% accurate for predicting SMA and CA stenoses/occlusions. CONCLUSIONS: Abdominal duplex scanning is a noninvasive technique that accurately detects total occlusions and objectively quantitates SMA and CA arterial stenoses.