title: Mesenteric/celiac duplex ultrasound interpretation criteria revisited.
abstract: BACKGROUND
  Several published studies with a small sample size have reported differing results of duplex ultrasound (DUS) utilizing different threshold velocities in detecting significant stenosis of superior mesenteric (SMA) or celiac arteries (CA). The present study is based on the largest number of mesenteric duplex/angiography correlations reported to date for the diagnosis of SMA/CA stenosis.
  
  
  METHODS
  One hundred fifty-three patients (151 SMA and 150 CA) had both DUS and arteriography. Receiver operator curves (ROC) were used to analyze peak systolic velocity (PSV), end diastolic velocity (EDV), and SMA or CA/aortic PSV ratio in detecting ≥50% and ≥70% stenosis.
  
  
  RESULTS
  For SMA (151 arteries: 84 with ≥50% stenosis [54 of which had ≥70% stenosis] based on angiography): the PSV threshold that provided the highest overall accuracy (OA) for detecting ≥50% SMA stenosis was ≥295 cm/s (sensitivity [sens.] 87%, specificity [spec.] 89%, and OA 88%); and for detecting ≥70% SMA, it was ≥400 cm/s (sens. 72%, spec. 93%, and OA 85%). The EDV threshold that provided the highest OA for detecting ≥50% stenosis was ≥45 cm/s (sens. 79%, spec. 79%, and OA 79%); and for ≥70% stenosis was ≥70 cm/s (sens. 65%, spec. 95%, and OA 84%). ROC analysis showed that PSV was better than EDV and SMA/aortic PSV ratio for ≥50% stenosis of SMA (P = .003 and P = .0005). For celiac arteries (150 arteries: 105 with ≥50% stenosis [62 of which had ≥70% stenosis]): the PSV threshold that provided the highest OA for ≥50% stenosis was ≥240 cm/s (sens. 87, spec. 83%, and OA 86%); and for ≥70% stenosis was ≥320 cm/s (sens. 80%, spec. 89%, and OA 85%). The EDV threshold that provided the highest OA for ≥50% stenosis was ≥40 cm/s (sens. 84%, spec. 48%, and OA 73%); and for ≥70% stenosis was ≥100 cm/s (sens. 58%, spec. 91%, and OA 77%). ROC analysis showed that PSV was better than EDV and SMA/aortic PSV ratio for ≥50% stenosis of CA (P < .0001 and P = .0410.)
  
  
  CONCLUSIONS
  PSV values can be used in detecting ≥50% and ≥70% SMA/CA stenosis and were better than EDVs and ratios. Previously published data must be validated in individual vascular laboratories. Our results will need prospective validation.
authors.affiliation: Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV 25304, USA. ali.aburahma@camc.org
authors.forename: Ali F
authors.initials: AF
authors.lastname: AbuRahma
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Stone
authors.forename: Mohit
authors.initials: M
authors.lastname: Srivastava
authors.forename: L Scott
authors.initials: LS
authors.lastname: Dean
authors.forename: Tammi
authors.initials: T
authors.lastname: Keiffer
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Hass
authors.forename: Albeir Y
authors.initials: AY
authors.lastname: Mousa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001027:Aortography; D001783:Blood Flow Velocity; D002445:Celiac Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007511:Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging* / Q000503:physiopathology; D065666:Mesenteric Ischemia; D008641:Mesenteric Vascular Occlusion / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012039:Regional Blood Flow; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018616:Ultrasonography, Doppler, Duplex; D014652:Vascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014903:West Virginia; D055815:Young Adult