Doppler ultrasonography of the upper mesenteric artery in chronic intestinal inflammation

Purpose. We evaluated the importance of dynamic studies of the superior mesenteric artery in defining the abnormal parameters that could help diagnose an inflammatory bowel disease. Material and methods. Our patient population consisted of 10 normal subjects, 10 patients with active and 10 with inactive Crohn disease; 10 patients with celiac disease were also examined, before treatment and then after 6 months' dieting. We used a 5 MHz transducer, with 2.8 MHz Doppler frequency and PRF of 5 KHz; longitudinal scans were performed at 2-3 cm from the origin, with 50-60 degrees Doppler angle. The examination was performed after overnight fasting and at least 5 minutes' supine recumbency and then repeated 15 minutes after ingestion of a liquid meal. We measured the resistive index (RI) both on fasting and after the meal; the parameter defined as resistive difference (RD) was used to measure postprandial changes in resistance. Results. In the healthy volunteers, RI on fasting was 0.81±0 .02, versus 0.67±0.03 after the meal (RD 0.14±0.2). In the patients with inactive Crohn disease, RI on fasting was 0.82±0.03, versus 0.69±0.04 15 minutes after the meal (RD 0.13±0.3). In the patients with active Crohn disease, RI on fasting was 0.78±0.03, versus 0.70±0.02 after the meal (RD 0.08±0.03). In the patients with untreated celiac disease, RI on fasting was 0.78±0.05, versus 0.74±0.01 15 minutes after the meal (RD 0.04±0.01). In the patients with treated celiac disease, RI on fasting was 0.79±0.03, versus 0.70±0.02 after the meal (RD 0.09±0.02). Conclusions. The evaluation of postprandial flow changes in the mesenteric district is of more than physiologic interest because it can be the only way to detect an inflammatory disease which becomes apparent only during functional stress. Doppler US can therefore be proposed as a follow-up method to assess acute phase regression.