Diagnostic value of conventional ultrasound and shear wave elastography in detecting transjugular intrahepatic portosystemic shunt dysfunction.

Abstract

BACKGROUND:

Transjugular intrahepatic portosystemic shunt (TIPS) dysfunction can cause recurrent portal hypertension (PH)-related complications such as ascites and gastroesophageal variceal bleeding. Portography is invasive and costly limits its use as a screening modality.

PURPOSE:

To assess the clinical value of conventional ultrasound in combination with point shear wave elastography (pSWE) to predict TIPS dysfunction.

MATERIAL AND METHODS:

A total of 184 patients with cirrhosis scheduled for TIPS implantation were enrolled in this study and evaluated retrospectively. The splenoportal venous blood flow parameter, liver stiffness (LS), and spleen stiffness (SPS) were measured. Outcome measures included differences in portal vein velocity (PVV), splenic vein velocity (SPVV), LS, and SPS. The accuracy of change in PVV (ΔPVV), SPVV (ΔSPVV), and SPS (ΔSPS) to diagnose TIPS dysfunction was investigated.

RESULTS:

TIPS dysfunction occurred in 28 of 184 patients (15.2%). Eighteen (64.3%) patients had shunt stenoses and 10 (35.7%) had shunt occlusion. Portal vein diameter (PVD), PVV, splenic vein diameter (SPVD), SPVV, LS, and SPS were not significantly different between the TIPS normal and TIPS dysfunction groups. Compared with the TIPS normal group, PVV and SPVV of the TIPS dysfunction group decreased significantly, whereas SPS increased significantly (P < 0.001). The values of areas under the receiver operating characteristic curves of ΔPVV, ΔSPVV, and ΔSPS for the diagnosis of TIPS dysfunction were 0.97, 0.96, and 0.87, respectively.

CONCLUSION:

pSWE showed a diagnostic efficacy comparable to conventional ultrasound for diagnosing TIPS dysfunction and can be used routinely after TIPS procedures.

• Authors: Hao Han, Jian Yang, Wei-Kui Jin, Xia Li, Feng Zhang, Yu-Zheng Zhuge, Min Wu, Bin Yang
• Journal: Acta radiologica (Stockholm, Sweden : 1987) (Acta Radiol) Vol. 62 Issue 12 Pg. 1575-1582 (Dec 2021) ISSN: 1600-0455 [Electronic] England
• PMID: 33251812 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Ascites (etiology)
• Blood Flow Velocity
• Elasticity
• Elasticity Imaging Techniques (methods)
• Esophageal and Gastric Varices (complications)
• Female
• Gastrointestinal Hemorrhage (etiology)
• Hepatic Veins
• Humans
• Hypertension, Portal (complications, virology)
• Liver (diagnostic imaging, physiopathology)
• Liver Cirrhosis (surgery, virology)
• Male
• Middle Aged
• Portal Vein (physiopathology)
• Portasystemic Shunt, Transjugular Intrahepatic (adverse effects)
• Portography (standards)
• Reference Standards
• Retrospective Studies
• Spleen (diagnostic imaging, physiopathology)
• Splenic Vein (physiopathology)
• Stents
• Ultrasonography (methods)