Abstract
Purpose
To determine the diagnostic value of contrast-enhanced ultrasound (CEUS) for the detection of TIPS (transjugular intrahepatic portosystemic shunt) complications.
Materials and method
67 cirrhotic patients who underwent TIPS between 2001 and 2008 were retrospectively reviewed. Sixty-two vascular examinations in 37 patients for suspicion of TIPS dysfunction based on the clinical or radiological criteria were analyzed and compared with the 62 related Doppler and CEUS examinations obtained previously. Abnormal CEUS was defined as poor opacification of the prosthesis compared to the native portal vein, stent stenosis, hepatic vein stenosis, and occlusion of the stent.
Results
Among the 62 vascular examinations, 56 were considered as pathologic, including: 20 occlusions, 25 stent stenoses, 9 hepatic vein stenoses, 1 arterial-TIPS fistula, and 1 strong flow stealing through a voluminous paraumbilical vein associated with a patent shunt. 50 were exactly correlated with a previous CEUS examination, including 20/20 occlusions (100%), 23/25 stent stenoses (91%), 5/9 hepatic vein stenoses (56%), 1/1 fistula (100%), and 1/1 strong flow stealing (100%). Two CEUS and 14 Doppler examinations were false negative.
Conclusion
CEUS allows direct visualization of intra-prosthetic flow, with a qualitative and anatomic study, in addition to the Doppler examination. This is a new, simple, and effective technique for TIPS follow-up.
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References
Richter GM, Noeldge G, Palmaz JC, et al. (1990) Transjugular intrahepatic portacaval stent shunt: preliminary clinical results. Radiology 174:1027–1030
Boyer TD (2008) Transjugular intrahepatic portosystemic shunt in the management of complications of portal hypertension. Curr Gastroenterol Rep 10:30–35
Bilbao JI, Quiroga J, Herrero JI, Benito A (2002) Transjugular intrahepatic portosystemic shunt (TIPS): current status and future possibilities. Cardiovasc Interv Radiol 25:251–269
Rossle M, Deibert P, Haag K, et al. (1997) Randomised trial of transjugular-intrahepatic-portosystemic shunt versus endoscopy plus propranolol for prevention of variceal rebleeding. Lancet 349:1043–1049
Ochs A, Rossle M, Haag K, et al. (1995) The transjugular intrahepatic portosystemic stent-shunt procedure for refractory ascites. N Engl J Med 332:1192–1197
Cura M, Cura A, Suri R, et al. (2008) Causes of TIPS dysfunction. AJR Am J Roentgenol 191:1751–1757
Ducoin H, El-Khoury J, Rousseau H, et al. (1997) Histopathologic analysis of transjugular intrahepatic portosystemic shunts. Hepatology 25:1064–1069
Latimer J, Bawa SM, Rees CJ, et al. (1998) Patency and reintervention rates during routine TIPSS surveillance. Cardiovasc Interv Radiol 21:234–239
Stanley AJ, Jalan R, Forrest EH, et al. (1996) Longterm follow up of transjugular intrahepatic portosystemic stent shunt (TIPSS) for the treatment of portal hypertension: results in 130 patients. Gut 39:479–485
Benito A, Bilbao J, Hernandez T, et al. (2004) Doppler ultrasound for TIPS: does it work? Abdom Imaging 29:45–52
Chong WK, Malisch TA, Mazer MJ, et al. (1993) Transjugular intrahepatic portosystemic shunt: US assessment with maximum flow velocity. Radiology 189:789–793
Longo JM, Bilbao JI, Rousseau HP, et al. (1993) Transjugular intrahepatic portosystemic shunt: evaluation with Doppler sonography. Radiology 186:529–534
Lafortune M, Martinet JP, Denys A, et al. (1995) Short- and long-term hemodynamic effects of transjugular intrahepatic portosystemic shunts: a Doppler/manometric correlative study. AJR Am J Roentgenol 164:997–1002
Foshager MC, Ferral H, Nazarian GK, et al. (1995) Duplex sonography after transjugular intrahepatic portosystemic shunts (TIPS): normal hemodynamic findings and efficacy in predicting shunt patency and stenosis. AJR Am J Roentgenol 165:1–7
Dodd GD, 3rd, Zajko AB, Orons PD et al. (1995) Detection of transjugular intrahepatic portosystemic shunt dysfunction: value of duplex Doppler sonography. AJR Am J Roentgenol 164:1119–1124
Feldstein VA, Patel MD, LaBerge JM (1996) Transjugular intrahepatic portosystemic shunts: accuracy of Doppler US in determination of patency and detection of stenoses. Radiology 201:141–147
Kanterman RY, Darcy MD, Middleton WD, et al. (1997) Doppler sonography findings associated with transjugular intrahepatic portosystemic shunt malfunction. AJR Am J Roentgenol 168:467–472
Owens CA, Bartolone C, Warner DL, et al. (1998) The inaccuracy of duplex ultrasonography in predicting patency of transjugular intrahepatic portosystemic shunts. Gastroenterology 114:975–980
Owens CA (1998) Ultrasound surveillance of tips-why bother? Gastroenterology 114:1433–1434
Zizka J, Elias P, Krajina A, et al. (2000) Value of Doppler sonography in revealing transjugular intrahepatic portosystemic shunt malfunction: a 5-year experience in 216 patients. AJR Am J Roentgenol 175:141–148
Carrafiello G (2006) Comparison of contrast-enhanced ultrasound and computed tomography in classifying endoleaks after endovascular treatment of abdominal aorta aneurysms: preliminary experience. Cardiovasc Interv Radiol 29:969–974
Clevert D-A (2007) Imaging of aortic abnormalities with contrast-enhanced ultrasound. A pictorial comparison with CT. Eur Radiol 17:2991–3000
Bilbao JI, Elorz M, Vivas I, et al. (2004) Transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of venous symptomatic chronic portal thrombosis in non-cirrhotic patients. Cardiovasc Interv Radiol 27:474–480
Lencioni R (2002) Tissue harmonic and contrast-specific imaging: back to gray scale in ultrasound. Eur Radiol 12:151–165
Lau CT, Scott M, Stavropoulos SW, et al. (2005) Dacron-covered stent-grafts in transjugular intrahepatic portosystemic shunts: initial experience. Radiology 236:725–729
Foshager MC, Ferral H, Finlay DE, et al. (1994) Color Doppler sonography of transjugular intrahepatic portosystemic shunts (TIPS). AJR Am J Roentgenol 163:105–111
Uggowitzer MM, Kugler C, Machan L, et al. (1998) Value of echo-enhanced Doppler sonography in evaluation of transjugular intrahepatic portosystemic shunts. AJR Am J Roentgenol 170:1041–1046
Furst G, Malms J, Heyer T, et al. (1998) Transjugular intrahepatic portosystemic shunts: improved evaluation with echo-enhanced color Doppler sonography, power Doppler sonography, and spectral duplex sonography. AJR Am J Roentgenol 170:1047–1054
Phillips P, Gardner E (2004) Contrast-agent detection and quantification. Eur Radiol 14(suppl 8):P4–P10
Martegani A, Aiani L, Borghi C (2004) The use of contrast-enhanced ultrasound in large vessels. Eur Radiol 14(suppl 8):P73–P86
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Micol, C., Marsot, J., Boublay, N. et al. Contrast-enhanced ultrasound: a new method for TIPS follow-up. Abdom Imaging 37, 252–260 (2012). https://doi.org/10.1007/s00261-011-9763-4
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DOI: https://doi.org/10.1007/s00261-011-9763-4