Journal of Ultrasound in Medicine, Vol 15, Issue 2 99-106, Copyright © 1996 by American Institute of Ultrasound in Medicine
Interobserver and inter-equipment variability of echo-Doppler sonographic evaluation of the superior mesenteric artery
M. Zoli, C. Merkel, C. Sabba, D. Sacerdoti, S. Gaiani, G. Ferraioli and L. Bolondi
Instituto di Clinica Medica Generale e Terapia Medica, University of Bologna, Italy.
The aim of this study was to assess the interobserver and inter-equipment
variabilities of echo-Doppler sonographic measurement of superior
mesenteric artery flow parameters. In the first part of the study the
echo-Doppler sonographic parameters (maximum systolic velocity, minimum
diastolic velocity, mean velocity, restrictive index, and pulsatility
index) were measured independently in nine patients by four skilled
operators using four different equipment models. In the second part of the
study measurements were taken by the four operators in seven different
patients, after one day of cooperative training; the purpose of this part
was to define a strict and uniform protocol of Doppler sonographic
examination. Significantly different values of maximum systolic velocity,
minimum diastolic velocity, mean velocity, and pulsatility index were
obtained by the different operators, whereas the inter-equipment
variability was significant only for maximum systolic velocity, mean
velocity, and pulsatility index. The analysis of the components of variance
showed that a large part of this variance was nonsystematic. After training
and definition of the protocol no significant differences 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 exists among mesenteric Doppler
measurements obtained by different operators using different commercially
available equipment. Cooperative training can reduce the interobserver
variability significantly and bring to an acceptable level the
reproducibility of Doppler measurements of superior mesenteric artery flow
parameters.