空腹及餐后双功超声检查对预测重度肠系膜上动脉狭窄的效用

Usefulness of fasting and postprandial duplex ultrasound examinations for predicting high-grade superior mesenteric artery stenosis.

作者信息

Gentile A T, Moneta G L, Lee R W, Masser P A, Taylor L M, Porter J M

机构信息

Department of Surgery, Oregon Health Sciences University, Portland, USA.

出版信息

Am J Surg. 1995 May;169(5):476-9. doi: 10.1016/S0002-9610(99)80198-6.

DOI:10.1016/S0002-9610(99)80198-6

PMID:7747822

Abstract

PURPOSE

A fasting duplex ultrasound examination of the superior mesenteric artery (SMA) accurately detects high-grade (> 70%) stenosis. It has been postulated that postprandial mesenteric duplex scanning may further stratify stenosis and improve the ability of a fasting examination to detect a high-grade stenosis. We performed fasting and postprandial duplex scanning of 25 healthy controls and 80 patients with vascular disease undergoing aortography to determine whether postprandial mesenteric duplex scanning provides information beyond a fasting study alone.

METHODS

Patients with vascular disease were divided into three groups based on lateral aortography results: group 1, 0% to < 30% SMA stenosis (n = 61); group 2, 30% to < 70% stenosis (n = 10); and group 3, 70% to 99% stenosis (n = 9). Fasting mesenteric duplex scanning was defined as positive for 70% to 99% stenosis if the peak systolic velocity (PSV) was > or = 275 cm/s. The ability of either fasting or postprandial mesenteric duplex scanning, and their combination, to predict high-grade (70% to 99%) SMA stenosis was determined using angiographic control.

RESULTS

Mean fasting SMA PSV did not differ among controls and groups 1 and 2. Postprandial PSV increased significantly in all groups, but was not different among controls and groups 1 and 2. Mean fasting PSV was significantly higher, and the postprandial increase in PSV significantly lower, in group 3 compared with controls and with groups 1 and 2. Fasting mesenteric duplex scanning predicted 70% to 99% SMA stenosis, with 89% sensitivity, 97% specificity, 80% positive predictive value, 99% negative predictive value, and 96% accuracy. Corresponding values for postprandial scanning were 67%, 94%, 60%, 96%, 91%, and for the combination of normal fasting and postprandial scanning 67%, 100%, 100%, 96%, 96%, respectively.

CONCLUSION

Postprandial increases in SMA PSVs are blunted in patients with high-grade stenosis, but feeding velocities do not stratify between lesser degrees of stenosis. Both fasting and postprandial PSVs identify high-grade (> 70%) stenosis. Their combination marginally improves fasting duplex scan specificity and positive predictive value. Postprandial scanning is not necessary for the diagnosis of high-grade stenosis if a fasting study identifies a PSV > or = 275 cm/s. The combination of normal fasting and postprandial mesenteric duplex ultrasound scanning may effectively rule out high-grade SMA stenosis.

摘要

目的

空腹状态下对肠系膜上动脉（SMA）进行双功超声检查可准确检测出重度（>70%）狭窄。据推测，餐后肠系膜双功扫描可能会进一步对狭窄程度进行分层，并提高空腹检查检测重度狭窄的能力。我们对25名健康对照者和80名接受主动脉造影的血管疾病患者进行了空腹和餐后双功扫描，以确定餐后肠系膜双功扫描是否能提供超出单纯空腹检查的信息。

方法

根据侧位主动脉造影结果，将血管疾病患者分为三组：第1组，SMA狭窄0%至<30%（n = 61）；第2组，狭窄30%至<70%（n = 10）；第3组，狭窄70%至99%（n = 9）。如果收缩期峰值流速（PSV）≥275 cm/s，则空腹肠系膜双功扫描定义为70%至99%狭窄阳性。使用血管造影对照确定空腹或餐后肠系膜双功扫描及其联合检查预测重度（70%至99%）SMA狭窄的能力。

结果

对照组与第1组和第2组之间的平均空腹SMA PSV无差异。所有组餐后PSV均显著升高，但对照组与第1组和第2组之间无差异。与对照组以及第1组和第2组相比，第3组的平均空腹PSV显著更高，餐后PSV升高显著更低。空腹肠系膜双功扫描预测70%至99% SMA狭窄的敏感性为89%、特异性为97%、阳性预测值为80%、阴性预测值为99%、准确性为96%。餐后扫描的相应值分别为67%、94%、60%、96%、91%，正常空腹和餐后扫描联合检查的相应值分别为67%、100%、100%、96%、96%。

结论

重度狭窄患者餐后SMA PSV的升高减弱，但进食后流速在较轻程度狭窄之间未分层。空腹和餐后PSV均可识别重度（>70%）狭窄。它们的联合检查在一定程度上提高了空腹双功扫描的特异性和阳性预测值。如果空腹检查发现PSV≥275 cm/s，则餐后扫描对于重度狭窄的诊断并非必需。正常空腹和餐后肠系膜双功超声扫描联合检查可有效排除重度SMA狭窄。