Faure Jean Michel, Larroque-Devigne Anne, Forgues Dominique, Mousty Eve, Couture Alain, Kalfa Nicolas, Prodhomme Olivier, Fuchs Florent
Department of Obstetrics and Gynecology, University Hospital Center, Montpellier, France.
Department of Abdominal and Urologic Surgery, CHU Montpellier, Hôpital Lapeyronie, Montpellier, France.
J Ultrasound Med. 2025 Jan;44(1):35-45. doi: 10.1002/jum.16576. Epub 2024 Sep 11.
Abnormal relative positioning of the superior mesenteric artery (SMA) and vein (SMV) can lead to intestinal malrotation that predisposes to midgut volvulus. The aim of this study was to assess the prenatal ultrasound ability to visualize the relative position of SMA and SMV in normal pregnancies.
Prospective cohort study performed in Montpellier University Hospital Centre, including 80 fetuses during routine 3rd trimester ultrasound scan. For each fetus included, the relative position of the vessels on an axial image was defined as SMV on the right, forward, or on the left of SMA. Doppler imaging was additionally used if necessary. Data were compared to the neonatal abdominal scans performed by pediatric radiologist.
The superior mesenteric vessels were identified in 79 fetuses. Prenatal findings showed a usual relative position of the vessels, that is, the vein on the right of the artery, in 96.2%. In 2 cases, the vein was strictly in front of the artery, and in 1 case, the vein was on the left side of the artery. Seventy-four neonates were examined and comparison with prenatal finding showed a perfect agreement (Kappa coefficient of 100%). An intestinal malrotation was postnatally diagnosed corresponding to the case where vein was on the left side of the artery.
This study showed that the relative position of the SMA and SMV could be assessed using ultrasound prenatal examination with a perfect agreement with postnatal findings. In case of abnormal vessels positioning more examinations should be promote including prenatal MRI and postnatal conventional radiologic examinations to confirm intestinal malrotation.
肠系膜上动脉（SMA）和肠系膜上静脉（SMV）的相对位置异常可导致肠旋转不良，进而易引发中肠扭转。本研究旨在评估产前超声观察正常妊娠中SMA和SMV相对位置的能力。
在蒙彼利埃大学医院中心进行的前瞻性队列研究，纳入80例孕晚期常规超声检查的胎儿。对于纳入的每例胎儿，在轴位图像上血管的相对位置定义为SMV在SMA的右侧、前方或左侧。必要时额外使用多普勒成像。将数据与儿科放射科医生进行的新生儿腹部扫描结果进行比较。
79例胎儿识别出肠系膜上血管。产前检查结果显示，96.2%的胎儿血管相对位置正常，即静脉在动脉右侧。2例静脉严格位于动脉前方，1例静脉位于动脉左侧。对74例新生儿进行检查，并与产前检查结果比较，显示完全一致（卡帕系数为100%）。产后诊断出1例肠旋转不良，对应静脉位于动脉左侧的病例。
本研究表明，产前超声检查可评估SMA和SMV的相对位置，与产后检查结果完全一致。若血管位置异常，应增加包括产前MRI和产后传统放射学检查在内的更多检查，以确诊肠旋转不良。
