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Abstract
compression phenomenon causing duodenal obstruction. CT angiography (CTA)
is the test of choice; ultrasound Doppler offers a noninvasive alternative. Aim:
to verify the diagnostic accuracy of both tests to verify an evidence-based
pathway in SMAS diagnosis.
Methods: A total of 48 patients suspected as SMAS were enrolled in this
prospective multicenter study. All patients had a standard ultrasound Doppler
and CTA protocol scan. Validity measures were based on the consensus
clinical diagnosis reference standard.
Results: Ultrasound sensitivity was 87.5% (95% CI 71.0–96.5) and the
specificity was 81.3% (95% CI 54.4–96.0) versus CTA specificity of 100%.
Patients who were obese (BMI >30; OR 6.7, p=0.003) and patients with bowel
gas (OR 8.2, p=0.001) showed high discordance rates by each definition. The
mean aortomesenteric angle difference between modalities was 2.3° (95% LoA:
−5.1°‐9.7°).
Conclusion: Ultrasound Doppler can be a valuable method for the primary
screening of SMAS, and high-BMI or surgical patients should receive CTA
examination for diagnosis verification of SMAS.
Keywords
Article Details
Copyright (c) 2025 Firas Abdullah Noori Al Baghdadi
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
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References
Welsch T, Büchler MW, Kienle P. Recalling superior mesenteric artery syndrome. Dig Surg. 2007;24(3):149-56.
doi:10.1159/000102097.
Shin MS, Kim JY. Optimal diagnostic approaches for superior mesenteric artery syndrome: a systematic review. Korean J
Radiol. 2019 Oct;20(10):1382-1391. doi:10.3348/kjr.2019.0322.
Neri S, Signorelli SS, Mondati E, et al. Ultrasound imaging in diagnosis of superior mesenteric artery syndrome. J
Ultrasound. 2022 Mar;25(1):59-65. doi:10.1007/s40477-021-00563-1.
Alkhatib AA, Elkhatib FA, Alkhatib MA. Superior Mesenteric Artery Syndrome: A Systematic Review of the Literature. J
Clin Med. 2023 Jan 26;12(3):961. doi:10.3390/jcm12030961.
Zhu ZZ, Qiu Y. Superior mesenteric artery syndrome: diagnosis and treatment from the gastroenterologist's view. J
Gastroenterol Hepatol. 2022 Feb;37(2):226-232. doi:10.1111/jgh.15720. (A recent review detailing clinical presentation,
pathophysiology, and management).
Uysal E, Aydin H, Kacar S. Assessment of the Aortomesenteric Angle and Distance in the Diagnosis of Superior
Mesenteric Artery Syndrome: The Role of Multidetector Computed Tomography. Korean J Radiol. 2023 Jan;24(1):73-80.
doi:10.3348/kjr.2022.0493.
Lee JY, Kim HC, Yang DM, et al. Comparative Effectiveness of CT and Ultrasonography for the Diagnosis of Superior
Mesenteric Artery Syndrome. Eur Radiol. 2023 Apr;33(4):2876-2885. doi:10.1007/s00330-022-09241-0.
8. O’Toole A, O’Toole M. Diagnostic Pitfalls in Superior Mesenteric Artery Syndrome. Cureus. 2025;17(11):e97858.
doi:10.7759/cureus.97858
Neri S, Signorelli SS, Mondati E, et al. Ultrasound imaging in diagnosis of superior mesenteric artery syndrome. J
Ultrasound. 2022 Mar;25(1):59-65. doi:10.1007/s40477-021-00563-1.
Lee JY, Kim HC, Yang DM, et al. Comparative Effectiveness of CT and Ultrasonography for the Diagnosis of Superior
Mesenteric Artery Syndrome. Eur Radiol. 2023 Apr;33(4):2876-2885. doi:10.1007/s00330-022-09241-0.
Shin YR, Kim SH, Kim HY. Superior mesenteric artery syndrome in children and adolescents: a 20-year experience at a
single center. Pediatr Radiol. 2023 Jan;53(1):133-141. doi:10.1007/s00247-022-05485-6.
Altiok H, Ozturk B, Korkmaz M, et al. Clinical and Radiological Features of Superior Mesenteric Artery Syndrome: A
Single-Center Experience. Turk J Gastroenterol. 2023;34(1):77-83. doi:10.5152/tjg.2022.22123.
Hegde A, Kadakia S, Sawant P. Superior Mesenteric Artery Syndrome: A Case Series Highlighting the Role of CT
Angiography. Indian J Radiol Imaging. 2022;32(3):386-391. doi:10.4103/ijri.ijri_42_22.
Park JH, Lee JS, Kim MJ, et al. Clinical and Radiologic Characteristics of Patients with Superior Mesenteric Artery
Syndrome: A Retrospective Study. Medicine (Baltimore). 2023;102(8):e32855. doi:10.1097/MD.0000000000032855.
Salazar A, Echeverri S, Tobón LF. Superior Mesenteric Artery Syndrome: An Overlooked Cause of Upper Gastrointestinal
Obstruction. Cureus. 2023;15(8):e43345. doi:10.7759/cureus.43345.
Ganschow P, Harnoss JM, Stüker D, et al. Superior mesenteric artery syndrome: quality of life after laparoscopic
duodenojejunostomy. Clin Case Rep. 2017;6(2):323-329. doi:10.1002/ccr3.1242.
Verma A, Garg K, Singh J. Role of Doppler Ultrasonography in the Diagnosis of Superior Mesenteric Artery Syndrome. J
Med Ultrasound. 2022;30(4):269-274. doi:10.4103/JMU.JMU_156_21.