Optimization of the Diagnosis of Celiac Trunk Compression Stenosis in Children: a Multimodal Approach

Objective . To optimize the diagnosis of celiac trunk compression stenosis in children by improving the accuracy of stenosis grading through the development of a universal measurement method. Materials and Methods . A retrospective analysis of duplex ultrasound protocols was conducted in 79 patients aged 4–17 years with suspected median arcuate ligament syndrome. The correlation between peak systolic velocity and stenosis percentage calculated by the NASCET scale was evaluated. The prospective part included 50 children (7 months — 17 years) with signs of extravascular compression. All underwent duplex ultrasound with vessel diameter measurements at four points and stenosis calculation using an original formula that accounts for post‑stenotic dilation and angular deformation.Subsequently, multidetector computed tomography angiography was performed for verification. Results . No reliable correlation was found between peak systolic velocity and NASCET stenosis percentage (r < 0.3, p > 0.05), due to the inability to correct the Doppler angle in the presence of vessel deformation. The new method standardized stenosis assessment by duplex ultrasound. In all cases, stenosis calculated by NASCET exceeded that obtained by the proposed formula. Duplex ultrasound and multidetector computed tomography angiography data using the new method were consistent (difference ≤ 5 %, intraclass correlation coefficient 0.92). Conclusion . The developed method for quantitative assessment of celiac trunk compression stenosis is universal, reproducible, and applicable to various imaging modalities. Its introduction into clinical practice will standardize diagnosis and provide a rationale for surgical treatment indications.