Duplexsonography of the mesenteric vessels – a critical evaluation of inter observer variability

Abstract

Introduction: The number of publications concerning mesenteric Doppler sonography (mesDS) is immense and does not correlate with the frequency of its use in clinical practice. This is astonishing since it provides real time blood flow (perfusion) information without side effects. Despite uncontrollable parameters like the technical limitations in some situations the optimization of (possibly) controllable parameters like standardization, production of normal values and reduction of the investigator variability by evaluating stable parameters could change the situation.

Patients and methods: 10 investigators experienced in abdominal sonography (“DEGUM-Seminarleiter”) performed mesenteric Doppler sonography in 5 healthy subjects with 5 different machines.

Results: The portal vein at the confluence and the common hepatic artery provide a significant portion of investigations with intromission angles of more than 60°. Values of diameter, resistance index and pulsatility index of the celiac trunc could be obtained with inter-observer variability values below 25 %. The proper and the common hepatic artery show no differences in inter-observer variability values, whereas the intrahepatic measure point of the portal vein showed a higher reproducibility.

Discussion: We define frame conditions for future mesenteric Doppler studies: the portal vein should be investigated at the intrahepatic measure point. Pathophysiological studies should refrain from velocity parameters except in the case of larger vessels running in a straight course towards the probe.

Zusammenfassung

Einleitung: Die Anzahl von Publikationen zum Thema mesenteriale Doppler-Sonografie ist immens und korreliert nicht mit der Häufigkeit der klinischen Anwendung. Dies ist insofern erstaunlich, als dass die Methode Blutflussinformationen in Echtzeit ohne Nebenwirkungen liefert. Trotz mancher unüberwindlicher Aspekte wie technische Limitationen könnte die Optimierung von kontrollierbaren Aspekten wie Standardisierung, Schaffung einer großen Basis von Normalwerten und Reduktion der Interobservervariabilität zwecks Erfassung reproduzierbarer Parameter die Situation verbessern.

Patienten und Methoden: 10 Untersucher mit Erfahrungen in der abdominellen Doppler-Sonografie (DEGUM-Seminarleiter) führten mesenteriale Doppler-Messungen an 5 gesunden Probanden an 5 verschiedenen Ultraschallgeräten durch.

Resultate: Messungen der Pfortader am Konfluenz angelotet und der Arteria hepatica communis führten zu einer hohen Rate an Messungen mit Einschallwinkeln über 60°. Diameter, Widerstands- und Pulsatilitätsindizes des Truncus coeliacus konnten mit einer Interobservervariabilität unter 25 % gemessen werden. Die Arteria hepatica communis und propria zeigen keine relevanten Unterschiede der Interobservariabilität, wohin gegen der intrahepatische Messort der Pfortader eine hohe Reproduzierbarkeit liefert

Diskussion: Wir schlagen Rahmenbedingungen für zukünftige Doppler-Studien vor: Die Pfortader sollte von interkostal transhepatisch gemessen werden. In pathophysiologischen Studien sollte von Messungen absoluter Geschwindigkeiten Abstand genommen werden außer bei Blutgefäßen mit geradem auf den Schallkopf gerichteten Verlauf.

Schlüsselwörter

Darm - infektiöse Kolitis - ischämische Kolitis - Sprue - chronisch entzündliche Darmerkrankung - Leber

Key words

bowel - infectious colitis - ischemic colitis - celiac disease - chronic inflammatory bowel disease - liver

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