Splanchnic Arterial Stenosis or Occlusion: Diagnosis at Doppler US1
Hyo K. Lim, MD,
Won J. Lee, MD,
Seung H. Kim, MD,
Soon J. Lee, MD,
Sang H. Choi, MD,
Hong S. Park, MD,
Young S. Do, MD,
Sung W. Choo, MD and
In W. Choo, MD
1 From the Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-ku, Seoul, Korea 135-710. From the 1996 RSNA scientific assembly. Received May 20, 1998; revision requested July 14; revision received August 25; accepted November 20. Address reprint requests to H.K.L.
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Figure 1a. True-positive Doppler US–based diagnosis of high-grade CA stenosis. (a) The peak systolic velocity of the proximal CA (arrow) on this abdominal Doppler US scan is greater than 400 cm/sec, which resulted in aliasing artifact. AO = abdominal aorta. (b) Lateral abdominal aortogram of the same region shows a tight stenosis (greater than 90%) at the proximal CA (arrowhead).
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Figure 1b. True-positive Doppler US–based diagnosis of high-grade CA stenosis. (a) The peak systolic velocity of the proximal CA (arrow) on this abdominal Doppler US scan is greater than 400 cm/sec, which resulted in aliasing artifact. AO = abdominal aorta. (b) Lateral abdominal aortogram of the same region shows a tight stenosis (greater than 90%) at the proximal CA (arrowhead).
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Figure 2a. True-positive Doppler US–based diagnosis of CA and SMA occlusion. (a) Longitudinal color Doppler scan of the abdominal aorta (AO) shows no color signal demonstrated in either the proximal CA or SMA. Note the reversed flow (encoded in blue) in a segment of the SMA (arrow). (b) Longitudinal color Doppler scan of the lower part of the abdominal aorta (AO) in a shows a hypertrophied inferior mesenteric artery (IMA). (c) On the lateral abdominal aortogram of the same region, the CA and SMA are not visible. A tortuous and enlarged inferior mesenteric artery (arrowheads) is demonstrated. (d) On the anteroposterior view of the delayed-phase aortogram of the same region, the SMA (arrows) and hepatic artery (arrowhead) are reconstituted through the enlarged inferior mesenteric artery.
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Figure 2b. True-positive Doppler US–based diagnosis of CA and SMA occlusion. (a) Longitudinal color Doppler scan of the abdominal aorta (AO) shows no color signal demonstrated in either the proximal CA or SMA. Note the reversed flow (encoded in blue) in a segment of the SMA (arrow). (b) Longitudinal color Doppler scan of the lower part of the abdominal aorta (AO) in a shows a hypertrophied inferior mesenteric artery (IMA). (c) On the lateral abdominal aortogram of the same region, the CA and SMA are not visible. A tortuous and enlarged inferior mesenteric artery (arrowheads) is demonstrated. (d) On the anteroposterior view of the delayed-phase aortogram of the same region, the SMA (arrows) and hepatic artery (arrowhead) are reconstituted through the enlarged inferior mesenteric artery.
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Figure 2c. True-positive Doppler US–based diagnosis of CA and SMA occlusion. (a) Longitudinal color Doppler scan of the abdominal aorta (AO) shows no color signal demonstrated in either the proximal CA or SMA. Note the reversed flow (encoded in blue) in a segment of the SMA (arrow). (b) Longitudinal color Doppler scan of the lower part of the abdominal aorta (AO) in a shows a hypertrophied inferior mesenteric artery (IMA). (c) On the lateral abdominal aortogram of the same region, the CA and SMA are not visible. A tortuous and enlarged inferior mesenteric artery (arrowheads) is demonstrated. (d) On the anteroposterior view of the delayed-phase aortogram of the same region, the SMA (arrows) and hepatic artery (arrowhead) are reconstituted through the enlarged inferior mesenteric artery.
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Figure 2d. True-positive Doppler US–based diagnosis of CA and SMA occlusion. (a) Longitudinal color Doppler scan of the abdominal aorta (AO) shows no color signal demonstrated in either the proximal CA or SMA. Note the reversed flow (encoded in blue) in a segment of the SMA (arrow). (b) Longitudinal color Doppler scan of the lower part of the abdominal aorta (AO) in a shows a hypertrophied inferior mesenteric artery (IMA). (c) On the lateral abdominal aortogram of the same region, the CA and SMA are not visible. A tortuous and enlarged inferior mesenteric artery (arrowheads) is demonstrated. (d) On the anteroposterior view of the delayed-phase aortogram of the same region, the SMA (arrows) and hepatic artery (arrowhead) are reconstituted through the enlarged inferior mesenteric artery.
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Figure 3a. False-positive Doppler US–based diagnosis of CA stenosis. (a) The peak systolic velocity of the proximal CA (arrow) on this abdominal Doppler US scan measured 247 cm/sec, which was considered to be abnormal on the basis of our Doppler US criteria. AO = abdominal aorta. (b) On the lateral abdominal aortogram of the same region, the CA (arrows) and SMA (arrowheads) show no evidence of high-grade stenosis. In this patient, the tortuous course of the CA may have contributed to the recording of high peak systolic velocities in an otherwise normal CA.
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Figure 3b. False-positive Doppler US–based diagnosis of CA stenosis. (a) The peak systolic velocity of the proximal CA (arrow) on this abdominal Doppler US scan measured 247 cm/sec, which was considered to be abnormal on the basis of our Doppler US criteria. AO = abdominal aorta. (b) On the lateral abdominal aortogram of the same region, the CA (arrows) and SMA (arrowheads) show no evidence of high-grade stenosis. In this patient, the tortuous course of the CA may have contributed to the recording of high peak systolic velocities in an otherwise normal CA.
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Figure 4a. True-positive Doppler US–based diagnosis of SMA stenosis. (a) The peak systolic velocity of the proximal SMA (arrow) on this abdominal Doppler US scan was 302 cm/sec. AO = abdominal aorta. (b) Lateral abdominal aortogram of the same region shows a tight stenosis (greater than 90%) of the proximal SMA (arrowhead).
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Figure 4b. True-positive Doppler US–based diagnosis of SMA stenosis. (a) The peak systolic velocity of the proximal SMA (arrow) on this abdominal Doppler US scan was 302 cm/sec. AO = abdominal aorta. (b) Lateral abdominal aortogram of the same region shows a tight stenosis (greater than 90%) of the proximal SMA (arrowhead).
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Figure 5a. False-positive Doppler US–based diagnosis of SMA stenosis. (a) The peak systolic velocity measured at the proximal SMA (arrow) on this abdominal Doppler US scan was 408 cm/sec. AO = abdominal aorta. (b) On the lateral abdominal aortogram of the same region, the CA (arrows) and SMA (arrowheads) show no evidence of high-grade stenosis. The proximal SMA has an acute angulation, which most likely led to an erroneous interrogation of the Doppler sample volume.
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Figure 5b. False-positive Doppler US–based diagnosis of SMA stenosis. (a) The peak systolic velocity measured at the proximal SMA (arrow) on this abdominal Doppler US scan was 408 cm/sec. AO = abdominal aorta. (b) On the lateral abdominal aortogram of the same region, the CA (arrows) and SMA (arrowheads) show no evidence of high-grade stenosis. The proximal SMA has an acute angulation, which most likely led to an erroneous interrogation of the Doppler sample volume.
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Copyright © 1999 by the Radiological Society of North America.
