Value of ultrasonography in diagnosis of superior mesenteric artery syndrome

doi:10.3877/cma.j.issn.2096-1537.2023.11.011

Abstract

Abstract:

Objective

To explore the diagnostic criteria of conventional ultrasound (US), oral contrast US, and their combination for superior mesenteric artery syndrome (SMAS) and compare their diagnostic value in this disease.

Methods

Fifty-one patients who visited the Sixth Affiliated Hospital of Sun Yat-sen University from February 2020 to February 2022 for unexplained abdominal pain, abdominal distension, nausea, vomiting, regurgitation, and loss of body mass and who underwent ultrasonography for clinically suspected SMAS were consecutively included. The angle between the abdominal aorta (AO) and the superior mesenteric artery (AMA) and the distance between the AO and the superior mesenteric artery (AMD) were recorded by conventional US. The duodenal internal diameter (D₁) within the angle between the AO and the superior mesenteric artery, the duodenal internal diameter (D₂) in front of the angle, and D₂/D₁ ratio were recorded by oral contrast US. All ultrasound data were analyzed retrospectively, and contrast-enhanced computed tomography (CECT) and barium meal examination were used as the gold standard of diagnosis. The diagnostic indexes of conventional US and oral contrast US were analyzed and obtained by receiver operating characteristic (ROC) curve analysis, and their diagnostic value was compared.

Results

According to ROC curve analysis, the indexes of conventional US for diagnosis of SMAS were AMA≤16° (area under the curve [AUC]=0.806) and AMD≤3.3 mm (AUC=0.685). The diagnostic indexes of oral contrast US for SMAS were D1≤5.5 mm (AUC=0.849), D2≥19 mm (AUC=0.725), and D₂/D₁ ratio ≥2.9 (AUC=0.884). The diagnostic criteria of conventional US, oral contrast US, and their combination for SMAS were AMA≤16° or AMD≤3.3 mm, D₂/D₁≥2.9, and AMA≤16° or AMD≤3.3 mm and D₂/D₁≥2.9, respectively; their sensitivity, specificity, and accuracy for diagnosis of SMAS were 95.2%, 53.3%, and 70.6% for conventional US, 85.7%, 83.3%, and 84.3% for oral contrast US, and 85.7%, 93.3%, and 90.2% for their combination.

Conclusion

Conventional US combined with oral contrast US is an effective solution for clinical diagnosis of SMAS.

Key words: Superior mesenteric artery syndrome, Conventional ultrasound, Oral contrast ultrasound, Diagnosis

Qingling Jiang, Si Qin, Meiyu Hu, Peiyi Xie, Guangjian Liu. Value of ultrasonography in diagnosis of superior mesenteric artery syndrome[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(11): 1174-1180.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2023.11.011

https://chaosheng.cma-cmc.com.cn/EN/Y2023/V20/I11/1174

Figures/Tables 4

References 18

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超声检查方法	诊断标准	敏感度（%）	特异度（%）	准确性（%）	阳性预测值（%）	阴性预测值（%）	AUC	95%CI
常规超声	AMA≤22°或AMD≤8 mm	100	20.0	52.9	46.7	100	0.600	0.453~0.735
	AMA≤16°或AMD≤3.3 mm	95.2	53.3	70.6	58.8	94.1	0.743	0.601~0.855
	AMA≤16°且AMD≤3.3 mm	42.9	86.7	68.6	69.2	68.4	0.648	0.501~0.776
口服胃窗造影剂超声	D₂/D₁>2.5	90.5	70.0	78.4	67.9	91.3	0.802	0.667~0.901
	D₂/D₁≥2.9	85.7	83.3	84.3	78.3	89.3	0.845	0.717~0.931
	符合三项指标中任意一项	90.5	73.3	80.4	70.4	91.7	0.819	0.686~0.913
	符合三项指标中任意两项	85.7	83.3	84.3	78.3	89.3	0.829	0.697~0.920
	三项指标同时符合	42.9	96.7	74.5	90.0	70.7	0.698	0.553~0.818
两者联合	AMA≤16°或AMD≤3.3 mm且D₂/D₁≥2.9	85.7	93.3	90.2	90.0	90.3	0.895	0.777~0.963

超声检查方法	诊断标准	敏感度（%）	特异度（%）	准确性（%）	阳性预测值（%）	阴性预测值（%）	AUC	95%CI
常规超声	AMA≤22°或AMD≤8 mm	100	20.0	52.9	46.7	100	0.600	0.453~0.735
	AMA≤16°或AMD≤3.3 mm	95.2	53.3	70.6	58.8	94.1	0.743	0.601~0.855
	AMA≤16°且AMD≤3.3 mm	42.9	86.7	68.6	69.2	68.4	0.648	0.501~0.776
口服胃窗造影剂超声	D₂/D₁>2.5	90.5	70.0	78.4	67.9	91.3	0.802	0.667~0.901
	D₂/D₁≥2.9	85.7	83.3	84.3	78.3	89.3	0.845	0.717~0.931
	符合三项指标中任意一项	90.5	73.3	80.4	70.4	91.7	0.819	0.686~0.913
	符合三项指标中任意两项	85.7	83.3	84.3	78.3	89.3	0.829	0.697~0.920
	三项指标同时符合	42.9	96.7	74.5	90.0	70.7	0.698	0.553~0.818
两者联合	AMA≤16°或AMD≤3.3 mm且D₂/D₁≥2.9	85.7	93.3	90.2	90.0	90.3	0.895	0.777~0.963

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