INTEROBSERVER AND INTER-EQUIPMENT VARIABILITY OF ECHO-DOPPLER SONOGRAPHIC EVALUATION OF THE SUPERIOR MESENTERIC-ARTERY

The aim of this study was to assess the interobserver and inter-equipm ent variabilities of echo-Doppler sonographic measurement of superior mesenteric artery flow parameters. Ln the first part of the study the echo-Doppler sonographic parameters (maximum systolic velocity minimum diastolic velocity, mean velocity, resistive index, and pulsatility i ndex) were measured independently in nine patients by four skilled ope rators using four different equipment models. In the second part of th e study measurements were taken by the four operators in seven differe nt patients, after one day of cooperative training; the purpose of thi s part was to define a strict and uniform protocol of Doppler sonograp hic examination. Significantly different values of maximum systolic ve locity, minimum diastolic velocity, mean velocity, and pulsatility ind ex were obtained by the different operators, whereas the inter-equipme nt variability was significant only for maximum systolic velocity, mea n velocity, and pulsatility index. The analysis of the components of v ariance showed that a large part of this variance was nonsystematic. A fter training and definition of the protocol no significant difference s were found among the operators for any of the parameters, and the 95 % confidence limits and coefficients of variation showed a decrease as for maximum systolic velocity, mean velocity, and pulsatility index. This study demonstrates that a significant systematic variability exis ts among mesenteric Doppler measurements obtained by different operato rs using different commercially available equipment. Cooperative train ing can reduce the interobserver variability significantly and bring t o an acceptable level the reproducibility of Doppler measurements of s uperior mesenteric artery flaw parameters.