Color Doppler Ultrasonic Observation Of The Superior Mesenteric Artery Main Branches

The superior mesenteric artery(superior mesenteric, artery, SMA) is the most important blood supply from theanterior wall of the digestive tract, abdominal aorta, forward and downward into the small bowel mesentery rootdownward, oblique, and extending to the right iliac fossa, the main branches of pancreaticoduodenal artery, jejunal artery, iliac artery, right colic artery, middle colic artery. Anatomy of the main branches, and repeated a branch, consistent through multilevel arterial arch straight arteries, issued by the final classification of arterial arch into the intestinal wall. The superior mesenteric artery and its main branches were adjacent to each other through theaortic arch anastomosis.Color Doppler ultrasound(Color Doppler flow imaging, CDFI) in color Doppler ultrasound based on superposition coding technology, two-dimensional ultrasound can obtain two-dimensional vascular clear multi section image, color Doppler ultrasonography and color Doppler signal of blood vessels, and blood flow spectrum signal measuring vessel within, to observe the frequency spectrum form, measure the hemodynamic parameters and so, CDFI has been widely used in cardiovascular diseases, abdominal aorta, blood vessels of limbs as the preferred examination method for evaluation of the vascular.At present, the CDFI application in SMA major to study its trunk, there are a number of scholars to due to the horizontal part of duodenum and the left renal vein compression through between the superior mesenteric artery syndrome and the nutcracker phenomenon to carry on the research of the superior mesenteric artery and abdominal aorta angle, CDFI is preferred methods for the diagnosis of the two diseases. There are a number of scholars use the mesenteric artery in the elderly hypertension, diabetes, these people were observed and hemodynamic parameters were determined, CDFI is found that thickening, mesenteric artery intima plaque, stenosis of reliable method. A short report by CDFI found that SMA spontaneous dissection, the branches of superior mesenteric artery pseudo aneurysm rare diseases. In pediatrics, researchers have superior mesenteric artery disease in children malrotation of intestine disease. A study of arterial blood flow change with feeding tolerance researchers in premature infants before the meal in superior mesenteric.Most scholars believe that the existence of CDFI in diagnosis of SMA by gas or substance interference, obesity can lead to SMA position, thus affecting the SMA display. These reasons make it in the SMA field is restricted. In order to reduce the interference and the content of intestinal gas, some scholars try to use the small intestine contrast agent can make the SMA display rate, but also can display the II and III branch, SMA can show blood flow signal at the same time, the intestinal wall.Through the small intestine contrast agent can improve the display rate of the branches of superior mesenteric artery but the operation time is long, can quickly check, a few patients can not eat will be limited.At present, the use of uncommon branches of the superior mesenteric artery with color Doppler ultrasound examination in the literature.Objective: To investigate the ability of color Doppler ultrasound in the main branch of the superior mesenteric artery under fasting conditions, evaluation of different scanning method shows the advantages and disadvantages of the branches of superior mesenteric artery, evaluate the hemodynamic characteristics of the branches of superior mesenteric artery.Methods: 1 inpatients and outpatients from Chengde central hospital were randomly selected 110 healthy adult male 55 cases, female 55 cases, age between 18~45 years old, average 35 years old. Check the instrument for the Holland PHILIPS IU22 color Doppler diagnostic instrument. The probe type is C5-1 convex array probe, the subjects were fasting 8 hours to accept the inspection, the operator by an experienced radiologists as. 2 Look for ways to superior mesenteric artery branch 2.1.Short axis scanning method for transverse abdominal probe subjects, showing short axis images of abdominal aorta and superior mesenteric artery, is a big and a small two circular echo free, is a big and a small two circular echo free, carefully observed rhythmic beat, superior mesenteric artery in the abdominal aorta in front, first find the mesenteric probe on the artery, and then slowly downward, continuous scanning, image display the vascular wall echo loss, that is, the branch to branch into the bar image translation, no echo or no echo extends outward, oval, the main stem is circular echo free, between drifting further and further away. 2.2 Long-axis translation scanning method for probe device shows superior mesenteric artery long axis at the same time, display and abdominal aorta. Show the superior mesenteric artery, artery before and after the wall is parallel and arranged. The central is no echo. Then the probe about slow sweep, looking for small artery on both sides of a circular or oval without echo, and the superior mesenteric artery without echo phase continuity. With all two conditions for branching. 2.3 using color Doppler to look for ways to probe into the subject: longitudinal abdominal mesenteric trunk axis, display, open the COLOR key, the color sampling frame size adjustment to fully display the superior mesenteric artery long axis, adjust the display color Doppler flow velocity scale to the blood vessels, no overflow or insufficient. The probe about slowly oscillating, observe the blood vessel internal color flow signal changes, round flashing blue or red blood flow signals in the trunk on both sides, which is a branch of superior mesenteric artery blood flow signal, rotating probe angle adjustment, display the long axis of the superior mesenteric artery, color flow signals were observed in blood vessel. 3 Each of the subjects are the three methods to find the superior mesenteric artery branch, branch number for each method were counted. Method for measuring diameter of superior mesenteric artery branch: 4 Through the three methods at the same time to confirm the branch, branch to take the short axis of the anterior and posterior wall of clear display, measuring the distance between the non echo between the anterior and posterior wall, which is SMA branch diameter in millimeters, retained two decimal point. 5 Method for the determination of the main branches of the superior mesenteric artery hemodynamic parameters Through the three methods at the same time that branch, SMA branch of long axis view, from the beginning of 0.5-1.0cm sampling, sample volume for the diameter of 1/2, the appropriate pressure and tilt angle probe, the Doppler beam and vascular angle is less than 60, and correction of sampling point, continuous take three clutter free, waveform morphology consistent to observe the blood flow velocity curve, morphology, blood flow parameters measurement of PSV and PDV, RI value. 6 Data collection and recording The use of ultrasound image workstation, record the general situation of the subjects, to record the numerical bifurcation image and spectrum for multiple images and blood flow parameters.Results:1 Among the tested 110, using the method of short axis continuous scan detected 712, an average of6.473±1.139, which up to 10, at least for three. Scan method by the use of long axis translation detected 732, an average of 6.655±0.999, which up to 10, at least for four. Using the method of color doppler detection, 803, each with 7.300±0.963; With up to 12, at least for 5 pieces. The average number of three methods were t test. See Synonyms at Table1, short axis and long axis translational scanning method between the P value of 0.156. P>0.05, indicating that both the obvious differences among the SMA branching ability, P<0.001 short axis scanning and color Doppler method two, axis shift P<0.001 scan between check method and color Doppler method, that between the two SMA branches were found no difference method.2 110 people tested measuring inner diameter 752 m of the mesenteric branch, its diameter is less than 2 mm has 7, accounted for 0.9%, with 111 m between 2 ~ 3 mm, accounted for 14.8%, with 209 m between 3 ~ 4 mm, the percentage is 27.8%, with 316 m between 4 ~ 5 mm, the percentage is 14.5%.3 measuring 734 SMA branch blood flow parameters of blood flow spectrum are shown for high-speed type high resistance, inner diameter size is negatively related with RI value.Conclusion:1 Under fasting conditions on the main branch of the superior mesenteric artery with color Doppler ultrasound can clearly display.2 For different branches of superior mesenteric artery scanning method for branch number had no obvious advantages and disadvantages of different methods, but can confirm each other, complement each other.3 Color Doppler ultrasound can be measured and the superior mesenteric artery and its main branches of the spectral images, and measure the hemodynamic parameters for further analysis.4 Inspection of the main branch of the superior mesenteric artery with color Doppler ultrasound in fasting conditions, has the value of clinical application.