Duplexsonographie der Viszeralarterien

Zusammenfassung

Obwohl die (Farb-)Duplexsonographie zur Messung der Blutströmung in den Mesenterialarterien schon vielfältig untersucht wurde und bei Darmerkrankungen eingesetzt worden ist, differieren die Untersuchungsprotokolle erheblich, da die Untersuchungstechnik bisher nicht ausreichend standardisiert worden ist. Es herrscht insbesondere keine Übereinstimmung bezüglich des Messortes und der zu erhebenden Messwerte. Lediglich hinsichtlich des Einschallwinkels besteht Einigkeit (< 60°). Anhand einer Literatursuche wurden die Untersuchungsmethoden und Ergebnisse analysiert. Diese Analyse soll als Grundlage für eine prospektive, multizentrische Studie zur Ermittlung von Normwerten dienen.

Duplex Sonography of Visceral Arteries - A Review of the Literature

Mesenterial bloodflow has been investigated routinely using colour Doppler ultrasound especially in patients with bowel disease. Examination protocols, however, differ considerably, because no standard technique has been established so far. Whereas there is agreement about the angle of ultrasonic application (< 60°), neither the exact location nor the relevant examination parameters have been standardized. Based on a search of the relevant literature, examination techniques and results were analysed. These findings are to serve as a basis for a prospective multi-center study for the determination of standard values.

Schlüsselwörter:

Mesenteriale Blutströmung - (Farb-)Duplexsonographie - Standardwerte - Untersuchungstechnik

Key words:

Mesenterial bloodflow - Colour Doppler ultrasound - Standard values - Examination technique

Literatur

• 1 Perko M J, Just S, Schroeder T V. Importance of diastolic velocities in the defection of celiac and mesenteric artery disease by duplex ultrasound.  J Vasc Surg. 1997;  26 288-293
• 2 Seitz K, Schäberle W. Duplex Sonography - Guide for the examination of abdominal vessel. Erlangen; Siemens Aktiengesellschaft - Medical Engineering Group 2000
• 3 Rizzo R J, Sandager G, Astleford P, Payne K, Peterson-Kennedy L, Flinn W R, Yao J S. Mesenteric flow velocity variations as a function of angle of insonation.  J Vasc Surg. 1990;  11 688-694
• 4 Perko M J, Perko G, Just S, Secher N H, Schroeder T V. Changes in superior mesenteric artery Doppler waveform during reduction of cardiac stroke volume and hypotension.  Ultrasound Med Biol. 1996;  22 11-18
• 5 Schäberle W, Seitz K. Duplex ultrasound measurement of blood flow in the superior mesenteric artery.  Ultraschall Med. 1991;  12 277-282
• 6 Ludwig D. Wertigkeit der dynamischen abdominellen Dopplersonographie in der Beurteilung von Schweregrad, Therapieerfolg und Prognose bei Leberzirrhose und chronisch entzündlichen Darmerkrankungen - Habilitationsschrift. 1999
• 7 Geelkerken R H, Delahunt T A, Schultze Kool L J, van Baalen J M, Hermans J, van Bockel J H. Pitfalls in the diagnosis of origin stenosis of the coeliac and superior mesenteric arteries with transabdominal color duplex examination.  Ultrasound Med Biol. 1996;  22 695-700
• 8 Van Oostayen J A, Wasser M N, Griffioen G, van Hogezand R A, Lamers C B, de Roos A. Diagnosis of Crohn's ileitis and monitoring of disease activity: value of Doppler ultrasound of superior mesenteric artery flow.  Am J Gastroenterol. 1998;  93 88-91
• 9 Jäger K, Kehl O, Ammann R, Bollinger A. Postprandial hyperemia of the superior mesenteric artery.  Schweiz Med Wochenschr. 1985;  115 1826-1829
• 10 Sieber C, Beglinger C, Jaeger K, Hildebrand P, Stalder G A. Regulation of postprandial mesenteric blood flow in humans: evidence for a cholinergic nervous reflex (see comments).  Gut. 1991;  32 361-366
• 11 Qamar M I, Read A E, Skidmore R, Evans J M, Wells P N. Pulsatility index of superior mesenteric artery blood velocity waveforms.  Ultrasound Med Biol. 1986;  12 773-776
• 12 Ray-Chaudhuri K, Ryder S A, Thomaides T, Mathias C J. The relationship between blood flow and pulsatility index in the superior mesenteric artery at rest and during constrictor stimuli in normal subjects.  J Clin Ultrasound. 1994;  22 149-160
• 13 Nakamura T, Moriyasu F, Ban N, Nishida O, Tamada T, Kawasaki T, Sakai M, Uchino H. Quantitative measurement of abdominal arterial blood flow using image-directed Doppler ultrasonography: superior mesenteric, splenic, and common hepatic arterial blood flow in normal adults.  J Clin Ultrasound. 1989;  17 261-268
• 14 Arienti V, Califano C, Brusco G, Boriani L, Biagi F, Giulia S M, Sottili S, Domanico A, Corazza G R, Gasbarrini G. Doppler ultrasonographic evaluation of splanchnic blood flow in coeliac disease.  Gut. 1996;  39 369-373
• 15 Sabba C, Ferraioli G, Genecin P, Colombato L, Buonamico P, Lerner E, Taylor K J, Groszmann R J. Evaluation of postprandial hyperemia in superior mesenteric artery and portal vein in healthy and cirrhotic humans: an operator-blind echo-Doppler study.  Hepatology. 1991;  13 714-718
• 16 Maconi G, Parente F, Bollani S, Imbesi V, Ardizzone S, Russo A, Bianchi P G. Factors affecting splanchnic haemodynamics in Crohn's disease: a prospective controlled study using Doppler ultrasound (see comments).  Gut. 1998;  43 645-650
• 17 Leen E, Angerson W G, Cooke T G, McArdle C S. Prognostic power of Doppler perfusion index in colorectal cancer. Correlation with survival.  Ann Surg. 1996;  223 199-203
• 18 Moneta G L, Yeager R A, Lee R W, Porter J M. Noninvasive localization of arterial occlusive disease: a comparison of segmental Doppler pressures and arterial duplex mapping.  J Vasc Surg. 1993;  17 578-582
• 19 Moneta G L, Yeager R A, Dalman R, Antonovic R, Hall L D, Porter J M. Duplex ultrasound criteria for diagnosis of splanchnic artery stenosis or occlusion (see comments).  J Vasc Surg. 1991;  14 511-518
• 20 Kathrein H, Dzien A, Schuhmayer R, Judmaier G, Braunsteiner H. Diagnosis of changes in blood flow in the inferior mesenteric artery in inflammatory bowel diseases with duplex sonography.  Vasa Suppl. 1990;  30 129-132
• 21 Mirk P, Palazzoni G, Cotroneo A R, di Stasi C, Fileni A. Sonographic and Doppler assessment of the inferior mesenteric artery: normal morphologic and hemodynamic features.  Abdom Imaging. 1998;  23 364-369
• 22 Sturm W, Judmaier G, Moriggl B, Kathrein H. Visualization of the inferior mesenteric artery in the ultrasound B image.  Ultraschall Med. 1995;  16 167-171
• 23 Dietrich C F, Brunner V, Seifert H, Schreiber-Dietrich D, Caspary W F, Lembcke B. Intestinal B-mode sonography in patients with endemic sprue. Intestinal sonography in endemic sprue.  Ultraschall Med. 1999;  20 242-247
• 24 Dietrich C F, Brunner V, Lembcke B. Intestinal ultrasound in rare small and large intestinal diseases.  Z Gastroenterol. 1998;  36 955-970
• 25 Qamar M I, Read A E, Skidmore R, Evans J M, Williamson R C. Transcutaneous Doppler ultrasound measurement of coeliac axis blood flow in man.  Br J Surg. 1985;  72 391-393
• 26 Muller A F. Role of duplex Doppler ultrasound in the assessment of patients with postprandial abdominal pain.  Gut. 1992;  33 460-465
• 27 Uzawa M, Karasawa E, Sugiura N, Saotome N, Kita K, Fukuda H, Miki M, Togawa Y, Kondou F, Matsutani S. Doppler color flow imaging in the detection and quantitative measurement of the gastroduodenal artery blood flow.  J Clin Ultrasound. 1993;  21 9-17
• 28 Aldoori M I, Qamar M I, Read A E, Williamson R C. Increased flow in the superior mesenteric artery in dumping syndrome.  Br J Surg. 1985;  72 389-390
• 29 Scheurlen M, Waller C, Hartmann F. In vivo validation of image-directed Doppler measurement of superior mesenteric artery blood flow.  J Clin Ultrasound. 1992;  20 19-26
• 30 Gentile A T, Moneta G L, Lee R W, Masser P A, Taylor L M Jr, Porter J M. Usefulness of fasting and postprandial duplex ultrasound examinations for predicting high-grade superior mesenteric artery stenosis.  Am J Surg. 1995;  169 476-479
• 31 Britton I, Maguire C, Adams C, Russell R I, Leen E. Assessment of the role and reliability of sonographic post-prandial flow response in grading Crohn's disease activity.  Clin Radiol. 1998;  53 599-603
• 32 Giovagnorio F. Doppler ultrasonography of the upper mesenteric artery in chronic intestinal inflammation.  Radiol Med (Torino). 1999;  98 43-47
• 33 Bolondi L, Gaiani S, Brignola C, Campieri M, Rigamonti A, Zironi G, Gionchetti P, Belloli C, Miglioli M, Barbara L. Changes in splanchnic hemodynamics in inflammatory bowel disease. Non-invasive assessment by Doppler ultrasound flowmetry.  Scand J Gastroenterol. 1992;  27 501-507
• 34 Van Oostayen J A, Wasser M N, van Hogezand R A, Griffioen G, de Roos A. Activity of Crohn disease assessed by measurement of superior mesenteric artery flow with Doppler US.  Radiology. 1994;  193 551-554
• 35 Sato S, Ohnishi K, Sugita S, Okuda K. Splenic artery and superior mesenteric artery blood flow: non-surgical Doppler US measurement in healthy subjects and patients with chronic liver disease.  Radiology. 1987;  164 347-352
• 36 Dauzat M, Lafortune M, Patriquin H, Pomier-Layrargues G. Meal induced changes in hepatic and splanchnic circulation: a noninvasive Doppler study in normal humans.  Eur J Appl Physiol. 1994;  68 373-380
• 37 Zwiebel W J, Mountford R A, Halliwell M J, Wells P N. Splanchnic blood flow in patients with cirrhosis and portal hypertension: investigation with duplex Doppler US.  Radiology. 1995;  194 807-812
• 38 Taourel P, Blanc P, Dauzat M, Chabre M, Pradel J, Gallix B, Larrey D, Bruel J M. Doppler study of mesenteric, hepatic, and portal circulation in alcoholic cirrhosis: relationship between quantitative Doppler measurements and the severity of portal hypertension and hepatic failure (see comments).  Hepatology. 1998;  28 932-936
• 39 Harward T R, Smith S, Seeger J M. Detection of celiac axis and superior mesenteric artery occlusive disease with use of abdominal duplex scanning.  J Vasc Surg. 1993;  17 738-745
• 40 Giovagnorio F, Diacinti D, Vernia P. Doppler sonography of the superior mesenteric artery in Crohn's disease.  Am J Roentgenol. 1998;  170 123-126
• 41 Ohmenhäuser A W. Duplexsonographische Blutflussmessung in der Arteria mesenterica inferior - Inaugural-Dissertation. Kreiskrankenhaus Böblingen (Akademisches Lehrkrankenhaus der Universität Tübingen) - Medizinsche Klinik, 1993.