# The diagnostic significance of Doppler ultrasound assessment of superior mesenteric artery hemodynamic changes in acute suppurative appendicitis: an integrated analysis of systemic inflammation and oxidative stress

## TL;DR

This study shows that Doppler ultrasound of the superior mesenteric artery can help diagnose acute suppurative appendicitis by detecting abnormal blood flow patterns linked to inflammation and oxidative stress.

## Contribution

The study introduces SMA hemodynamic parameters as a non-invasive diagnostic tool for acute suppurative appendicitis when direct imaging is not possible.

## Key findings

- ASA patients showed significantly higher SMA peak systolic velocity, resistance index, and systolic/diastolic ratio compared to controls.
- PSV with a cutoff of 157.5 cm/s had an AUC of 0.89, indicating strong diagnostic potential for acute suppurative appendicitis.
- Elevated SMA-PSV correlates with systemic inflammation, oxidative stress, and ferroptosis-related molecules in ASA patients.

## Abstract

This study aimed to evaluate the hemodynamic changes of the superior mesenteric artery (SMA) in patients with acute suppurative appendicitis (ASA) and to explore its diagnostic value. A retrospective study was conducted on 103 patients diagnosed with ankylosing spondylitis (ASA) by ultrasound examination and pathology at our hospital between January 2015 and December 2022, who were included in the ASA group. Another 98 healthy volunteers with normal physical examination results in 2021 were selected as the control group. Hemodynamic parameters of spondylitis were measured by ultrasound, including peak systolic velocity (PSV), end-diastolic velocity (EDV), resistance index (RI), and systolic/diastolic ratio (S/D). Receiver operating characteristic (ROC) curves were plotted for statistically significant parameters, and their optimal cutoff values were determined. Compared with the control group, the PSV, RI, and S/D values of the ASA group were significantly increased, and the differences were statistically significant (all p < 0.05). The median PSV in the ASA group was 215.9 cm/s (interquartile range: 169.1–233.7 cm/s), while that in the control group was 132.8 cm/s (interquartile range: 118.1–155.0 cm/s). The RI in the ASA group was 0.83 (interquartile range: 0.79–0.85), while that in the control group was 0.73 (interquartile range: 0.69–0.77). The S/D ratio in the ASA group was 5.8 (interquartile range: 4.7–6.7), significantly higher than that in the control group was 3.7 (interquartile range: 3.2–4.4). ROC curve analysis showed that the optimal cutoff value for PSV was 157.5 cm/s, and its area under the curve (AUC) was 0.89. Ultrasound assessment of superior mesenteric artery hemodynamics is of significant value in the auxiliary diagnosis of acute suppurative appendicitis (ASA). Elevated SMA-PSV is closely associated with systemic inflammatory response, oxidative stress, and the expression of ferroptosis-related molecules, and can serve as a reliable indicator of the pathophysiological state of ASA. When direct ultrasound imaging of the appendix is limited, SMA hemodynamic measurement can serve as a non-invasive alternative method to aid in early diagnosis and clinical decision-making.