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

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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.

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About the authors

Sergey A. Muslov

Russian University of Medicine

Author for correspondence.
Email: muslov@mail.ru
ORCID iD: 0000-0002-9752-6804
SPIN-code: 7213-2852

Cand. Sci. (Physics and Mathematics), Dr. Sci. (Biology), Professor of the Department of Normal Physiology and Medical Physics

Russian Federation, Moscow

Aleksandr A. Solodov

Russian University of Medicine

Email: Docsol@mail.ru
ORCID iD: 0000-0002-8263-1433
SPIN-code: 6946-8672

MD, Dr. Sci. (Medicine), Director of the Scientific and Educational Institute of Clinical Medicine named after Semashko, Head of the Department of Anesthesiology, Reanimatology and Intensive Care

Russian Federation, Moscow

Sergey S. Pertsov

Russian University of Medicine; Federal Research Center for Innovator and Emerging Biomedical and Pharmaceutical Technologies

Email: s.pertsov@mail.ru
ORCID iD: 0000-0001-5530-4990
SPIN-code: 3876-0513

Head of the Department of Normal Physiology and Medical Physics, Director of Anokhin Research Institute of Normal Physiology

Russian Federation, Moscow; Moscow

Liudmila I. Merkusheva

Pirogov Russian National Research Medical University

Email: merkusheva_li@rgnkc.ru
ORCID iD: 0000-0003-2112-9164
SPIN-code: 9262-7711

MD, Cand. Sci. (Medicine), nephrologist, geriatrician, Research Associate at the Laboratory of Age-Related Metabolic and Endocrine Disorders

Russian Federation, Moscow

Konstantin V. Bylov

Center for Endosurgery and Lithotripsy

Email: konstantin.bylov@gmail.com
ORCID iD: 0009-0007-0373-6071

cardiovascular, endovascular surgeon, the Head of Cardiovascular Department

Russian Federation, Moscow

Pavel Y. Sukhochev

Lomonosov Moscow State University

Email: ps@moids.ru
ORCID iD: 0000-0002-8004-6011
SPIN-code: 7780-8694

Research Associate at the Laboratory of Mathematical Support for Simulation Dynamic Systems, Department of Applied Research, Faculty of Mechanics and Mathematics

Russian Federation, Moscow

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. 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
  3. 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.
  4. Taylor DC, Moneta GL. Duplex ultrasound scanning of the renal and mesenteric circulations. Semin Vasc Surg. 1988;1:23–31.
  5. 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
  6. 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
  7. 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
  8. 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
  9. 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.)
  10. 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
  11. 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
  12. 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
  13. Elizarova RA. Practical Dopplerography of BCA, CVC, visceral and peripheral vessels. Reference materials. Saint Petersburg; 2022. 591 p. (In Russ.)
  14. 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
  15. Lelyuk VG, Lelyuk SE. Ultrasound angiology. Moscow: Real time; 2003. 322 p. (In Russ.)
  16. Levtov VA, Regirer SA, Shadrina NH. Rheology of blood. Moscow: Meditsina; 1982. 272 p. (In Russ.)
  17. 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
  18. 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

Supplementary files

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2. Fig. 1. Stenosis (>90%) of the celiac trunk ostium. The arrow shows the area of stenosis, aortogram [8]

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3. Fig. 2. Curves of the degree of stenosis–blood flow velocity for different numerical values of vnorm (vpor, Stpor) according to the data of works [8] (1), [7] (2), [1] (3), [5] (4, control), [9] (5). Points (6) correspond to clinical data [5] obtained on 34 patients with significant atherosclerosis of the celiac arteries, visualized angiographically

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4. Fig. 3. Absolute deviation values of ultrasound from angiographic data for celiac trunk stenosis. Outlier points (points beyond ±1.5IQR, where IQR is the interquartile range) are shown

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5. Fig. 4. Calculated dependencies “degree of stenosis of the celiac trunk–peak systolic velocity” and clinical data. Markers: dots — results of calculation based on formulas (3) and (4) for accepted values of normal and threshold blood flow velocities; squares — clinical data [5]; diamonds — clinical examples. Dotted lines — threshold values v = 200 cm/s and St = 70% [6, 8]. FN, TP, TN and FP — zones of interpretation of the results of the ultrasound doppler test: TP — true positive; TN — true negative; FP — false positive; FN — false negative

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6. Fig. 5. Increased peak systolic velocity (ПСС) and end diastolic velocity (КДС) at the celiac trunk ostium. Peak systolic velocity 349 cm/s, end diastolic velocity 317 cm/s, resistance index (ИР) 0.09. Thermal index TI 0.6, mechanical index MI 0.3. Dopplerographic signs of celiac trunk stenosis (ЧС). (Russian Scientific Clinical Center of the Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation)

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7. Fig. 6. Increased peak systolic velocity of the celiac trunk at the celiac trunk ostium. Peak systolic velocity 188 cm/s. Thermal index TI 0.5, mechanical index MI 0.4. Dopplerographic signs of stenosis of the celiac trunk. (Kuskovo Medical Center of the Russian University of Medicine, Ministry of Health of the Russian Federation)

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8. Fig. 7. CT angiography of the celiac trunk. Stenosis 35%. (Kuskovo Medical Center of the Russian University of Medicine, Ministry of Health of the Russian Federation)

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9. Fig. 8. Dependence of the measurement error of peak systolic velocity on the value of the Doppler angle

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