To clarify the criteria for stenosis of the celiac artery during ultrasound duplex scanning

Abstract

BACKGROUND: Criteria for stenosis of the celiac artery in duplex ultrasound diagnostics based on measurements of peak systolic velocity of blood flow are still a discussed topic for the diagnosis of blood flow disorders in the branches of the abdominal aorta.

AIM: To clarify the calculation formulas for determining the degree of emergency stenosis based on the literature speed indicators, compare the results obtained with each other and with angiographic data.

MATERIALS AND METHODS: When calculating the dependence of the degree of stenosis on the speed of blood flow, the theoretical prerequisites of the mechanics of incompressible fluids, one of which is whole blood, were used. The Mathcad 15.0 algebraic computing software package was used. Data correlation was evaluated using the corr functional using the Pearson correlation coefficient. The value of the correlation coefficient was interpreted using the Cheddock scale. The relationship between the results of ultrasound and angiographic data was also considered using the concepts of evidence-based medicine for diagnostic tests (sensitivity, specificity, predictive value and accuracy).

RESULTS: Statistical indicators of the “discrepancy” of the data obtained from the above calculation formulas and clinical angiographic observations were: standard deviation SD 25.90%, maximum absolute deviation Δ 93.71% and reduced error δ 93.71%. The correlation of the average strength between the Doppler and the corresponding angiographic data was established (R = 0.467). The indicators of ultrasound tests generally correspond to angiographic data and are characterized on average by the following parameters: sensitivity Se = 100%, specificity Sp = 75.02, prognostic values PPV = 50.00%, NPV = 100% and overall accuracy P = 78.79%.

CONCLUSIONS: It is concluded that the ultrasonographic duplex scanning data can be considered as satisfactorily determining the percentage of stenosis, which corresponds to the literature data on the ultimate sensitivity, specificity and prognostic value of detecting abdominal artery stenosis based on peak systolic velocity. At the same time, the given calculation formulas for the degree of stenosis, depending on the velocity parameters of blood flow, generally correctly reflect the degree of circulatory disorders in the abdominal trunk. Finally, the issue of the hemodynamic significance of disorders and the pathogenetic basis of the disease should be resolved on the basis of angiographic indicators.

Keywords

celiac artery / stenosis / criteria / ultrasonographic duplex scanning / angiography

References

[1] Hamid ZM, Vasilevsky DI, Korolkov AY, Balandov SG. Celiac trunk compression syndrome: modern concepts of the problem (literature review). Uchenyye zapiski SPbGMU im. akad. I.P. Pavlova. 2020;27(3):23–28. (In Russ.) EDN: UQGGUO doi: 10.24884/1607-4181-2020-27-3-23-28

[2] Хамид З.М., Василевский Д.И., Корольков А.Ю., Баландов С.Г. Синдром компрессии чревного ствола: современные представления о проблеме (обзор литературы) // Ученые записки СПбГМУ им. акад. И.П. Павлова. 2020. Т. 27, № 3. С. 23–28. EDN: UQGGUO doi: 10.24884/1607-4181-2020-27-3-23-28

[3] Nicholls SC, Kohler TR, Martin RL, Strandness DE. Use of hemodynamic parameters in the diagnosis of mesenteric insufficiency. J Vasc Surg. 1986;3:507–510. doi: 10.1067/mva.1986.avs0030507

[4] Nicholls S.C., Kohler T.R., Martin R.L., Strandness D.E. Use of hemodynamic parameters in the diagnosis of mensenteric insufficiency // J Vasc Surg. 1986. Vol. 3. P. 507–510. doi: 10.1067/mva.1986.avs0030507

[5] Flinn WR, Sandager GP, Lilly M, et al. Duplex scan of mesenteric and celiac arteries. In: Bergan JJ, Yao JST, eds. Arterial surgery: new diagnostic and operative techniques. Orlando: Grune and Stratton; 1988. P. 367–75.

[6] Flinn W.R., Sandager G.P., Lilly M. et al. Duplex scan of mesenteric and celiac arteries. In: Bergan J.J., Yao J.S.T., eds. Arterial surgery: new diagnostic and operative techniques. Orlando: Grune and Stratton, 1988. P. 367–375.

[7] Taylor DC, Moneta GL. Duplex ultrasound scanning of the renal and mesenteric circulations. Semin Vasc Surg. 1988;1:23–31.

[8] Taylor D.C., Moneta G.L. Duplex ultrasound scanning of the renal and mesenteric circulations // Semin Vasc Surg. 1988. Vol. 1. P. 23–31.

[9] Moneta GL, Yeager RA, Dalman R, et al. Duplex ultrasound criteria for diagnosis of splanchnic artery stenosis or occlusion. J Vasc Surg. 1991;14(4):511–518; discussion 518–520. doi: 10.1016/0741-5214(91)90245-p

[10] Moneta G.L., Yeager R.A., Dalman R. et al. Duplex ultrasound criteria for diagnosis of splanchnic artery stenosis or occlusion // J Vasc Surg. 1991. Vol. 14, N 4. P. 511–518; discussion 518–520. doi: 10.1016/0741-5214(91)90245-p

[11] Barkhatov IV, Barkhatova NA. Ultrasound methods and criteria for diagnosing pathology of the unpaired visceral branches of the abdominal aorta (literature review). Journal of new medical technologies, еEdition. 2017. № 1. С. 270–277. EDN: YHVBRT doi: 10.12737/25098

[12] Бархатов И.В., Бархатова Н.А. Ультразвуковые методы и критерии диагностики патологии непарных висцеральных ветвей брюшной аорты (обзор литературы) // Вестник новых медицинских технологий. Электронное издание. 2017. № 1. С. 270–277. EDN: YHVBRT doi: 10.12737/25098

[13] Bowersox JC, Zwolak RM, Walsh DB. Duplex ultrasound criteria for diagnosis of celiac and mesenteric artery occlusive disease. J Vasc Surg. 1991;14:780–788. doi: 10.1067/mva.1991.33215

[14] Bowersox J.C., Zwolak R.M., Walsh D.B. Duplex ultrasound criteria for diagnosis of celiac and mesenteric artery occlusive disease // J Vasc Surg. 1991. Vol. 14. P. 780–788. doi: 10.1067/mva.1991.33215

[15] Lim HK, Lee WJ, Kim SH. Splanchnic arterial stenosis or occlusion: Diagnosis at Doppler. Radiology. 1999;211:405–410. doi: 10.1148/radiology.211.2.r99ma27405

[16] Lim H.K., Lee W.J., Kim S.H. Splanchnic arterial stenosis or occlusion: Diagnosis at Doppler // Radiology. 1999. Vol. 211. P. 405–410. doi: 10.1148/radiology.211.2.r99ma27405

[17] Surnina EE, Kinzerskaya ML, Dulkin LA, Kinzersky AY. Criteria for assessing the hemodynamic significance of abnormalities and compression lesions of celiac trunk in children with diseases of the top sections of a digestive tract. Gastroenterology. 2014;1(77):60–64. (In Russ.)

[18] Сурнина Е.Е., Кинзерская М.Л., Дулькин Л.А., Кинзерский А.Ю. Критерии оценки гемодинамической значимости аномалий и компрессионных поражений чревного ствола у детей с заболеваниями верхних отделов пищеварительного тракта // Гастроэнтерология. 2014. Т. 1, № 77. С. 60–64.

[19] AbuRahma AF, Stone PA, Srivastava M, et al. Mesenteric/celiac duplex ultrasound interpretation criteria revisited. J Vasc Surg. 2012;55(2):428–436.e6. doi: 10.1016/j.jvs.2011.08.052

[20] AbuRahma A.F., Stone P.A., Srivastava M. et al. Mesenteric/celiac duplex ultrasound interpretation criteria revisited // J Vasc Surg. 2012. Vol. 55, N 2. P. 428–436.e6. doi: 10.1016/j.jvs.2011.08.052

[21] Zwolak RM, Fillinger MF, Walsh DB, et al. Mesenteric and celiac duplex scanning: a validation study. J Vasc Surg. 1998;27:1078–1088. doi: 10.1016/s0741-5214(98)60010-0

[22] Zwolak R.M., Fillinger M.F., Walsh D.B., et al. Mesenteric and celiac duplex scanning: a validation study // J Vasc Surg. 1998. Vol. 27. P. 1078–1088. doi: 10.1016/s0741-5214(98)60010-0

[23] Perko MJ, Just S, Schroeder TV. Importance of diastolic velocities in the detection of celiac and mesenteric artery disease by duplex ultrasound. J Vasc Surg. 1997;26:288–293. doi: 10.1016/s0741-5214(97)70191-5

[24] Perko M.J., Just S., Schroeder T.V. Importance of diastolic velocities in the detection of celiac and mesenteric artery disease by duplex ultrasound // J Vasc Surg. 1997. Vol. 26. P. 288–293. doi: 10.1016/s0741-5214(97)70191-5

[25] Elizarova RA. Practical Dopplerography of BCA, CVC, visceral and peripheral vessels. Reference materials. Saint Petersburg; 2022. 591 p. (In Russ.)

[26] Елизарова Р.А. Практическая допплерография БЦА, ЦВК, висцеральных и периферических сосудов. Справочные материалы. Санкт-Петербург, 2022. 591 с.

[27] Korneenkov AA, Ryazantsev SV, Vyazemskaya EE. Symptom dynamics assessment of the disease by methods of survival analysis. Medical Council. 2019;(20):45–51. EDN: FMTNPQ doi: 10.21518/2079-701X-2019-20-45-51

[28] Корнеенков А.А., Рязанцев С.В., Вяземская Е.Э. Вычисление и интерпретация показателей информативности диагностических медицинских технологий // Медицинский совет. 2019. № 20. С. 45–51. EDN: FMTNPQ doi: 10.21518/2079-701X-2019-20-45-51

[29] Lelyuk VG, Lelyuk SE. Ultrasound angiology. Moscow: Real time; 2003. 322 p. (In Russ.)

[30] Лелюк В.Г., Лелюк С.Э. Ультразвуковая ангиология. Москва: Реальное время, 2003. 322 c.

[31] Levtov VA, Regirer SA, Shadrina NH. Rheology of blood. Moscow: Meditsina; 1982. 272 p. (In Russ.)

[32] Левтов В.А., Регирер С.А., Шадрина Н.Х. Реология крови. Москва: Медицина, 1982. 272 с.

[33] Malota Z, Glowacki J, Sadowski W, et al. Numerical analysis of the impact of flow rate, heart rate, vessel geometry, and degree of stenosis on coronary hemodynamic indices. BMC Cardiovasc Disord. 2018;18:132. doi: 10.1186/s12872-018-0865-6

[34] Malota Z., Glowacki J., Sadowski W. et al. Numerical analysis of the impact of flow rate, heart rate, vessel geometry, and degree of stenosis on coronary hemodynamic indices // BMC Cardiovasc Disord. 2018. Vol. 18. P. 132. doi: 10.1186/s12872-018-0865-6

[35] Stein P, Sabbah H. Measured turbulence and its effects on thrombus formation. Circ Res. 1974;35(4):608–614. doi: 10.1161/01.res.35.4.608

[36] Stein P., Sabbah H. Measured turbulence and its effects on thrombus formation // Circ Res. 1974. Vol. 35, N 4. P. 608–614. doi: 10.1161/01.res.35.4.608

RIGHTS & PERMISSIONS

Eco-Vector