[Follow-up of TIPSS by color-coded duplex sonography using an ultrasonic signal enhancer. First results]. / TIPSS-Kontrolle mit Farbduplexsonographie unter Anwendung eines Ultraschallverstärkungsmittels. Erste Ergebnisse.

A study was performed to determine the visualization of the transjugular intrahepatic portosystemic stent shunt (TIPSS) and the detection of stenosis by the use of a capillary transversing signal enhancer. In 37 patients 37 colour-coded duplex sonographies were performed before and after intravenous injection of the ultrasound signal enhancer Levovist (Schering, Berlin). The examinations were evaluated using a four-category score. Special attention was paid to the detection of stenoses in the TIPSS. Transjugular portal venograms of the same day were used as gold standard. The use of Levovist provided better colour and flow signals for the portal vein end of the shunt in only 9 of 37 sonograms and for the hepatic vein end of the shunt in 37 of 39 sonograms. Eleven of 13 stenoses requiring reintervention in portal venography could be correctly identified with signal enhancer. Eleven of these 13 stenoses were located in the hepatic vein end of the shunt. Ultrasound signal enhancer can significantly improve the sonomorphological visualization especially of the hepatic vein end of TIPSS in colour-coded duplex sonography. Stenoses which usually occur in the hepatic vein end of the shunt may be better detected.

[After-care of TIPSS patients. Comparison between color Doppler ultrasound and portography]. / Nachsorge bei TIPPS. Vergleich zwischen Farbdopplersonographie und Portographie.

PURPOSE: Comparison of color Doppler sonography and venous portography in patients with a transjugular intrahepatic portosystemic stent shunt (TIPSS). MATERIALS AND METHODS: In a prospective study 40 consecutive patients with TIPSS underwent venous portography and color Doppler sonography on the same day as follow-up. Shunt velocities were recorded within the TIPSS at the proximal (hepatic vein segment) and distal part (portal vein segment). RESULTS: In 28 patients with functioning TIPSS the mean shunt velocity ranged between 30 and 120 cm/s (median 60 cm/s) at the portal vein segment and between 60 and 155 cm/s (median 82 cm/s) at the hepatic vein segment. There was a significant increase of the mean shunt velocity in the hepatic vein segment (P < 0.001). In 12 patients with compromised TIPSS the mean shunt velocity was reduced to 26 +/- 7 cm/s at the portal venous end (P < 0.0001). CONCLUSION: Because of an accelerated shunt velocity in the hepatic vein segment a site-specific evaluation of both TIPSS endings is necessary with color Doppler sonography. In compromised TIPSS the shunt velocity is reduced at the portal venous end. Color Doppler sonography is a valid non-invasive means for follow-up of patients with TIPSS.

[Use of the ultrasound contrast medium levovist in after-care of liver transplant patients. Improved vascular imaging in color Doppler ultrasound]. / Der Einsatz des Ultraschallkontrastmittels Levovist in der Nachsorge von Lebertransplantationen. Verbesserung der Gefässdarstellung in der Farbdopplersonographie.

INTRODUCTION: A study was carried out to determine whether an improvement in the detection of vascular signals in patients after orthotopic liver transplantation can be achieved by the use of ultrasound contrast medium in colour Doppler sonography. MATERIAL AND METHODS: In the early postoperative follow-up of liver transplant recipients, 31 colour Doppler sonograms were obtained in 21 patients before and after intravenous injection of the ultrasound contrast agent Levovist (Schering, Berlin). A grading score with four categories was used to evaluate the sonograms with special regard to the visibility of colour and flow signals in the hepatic artery and also in the portal vein and the hepatic veins. The arterial and portal venous signals were evaluated in the hepatic portal and in the left and right lobe. RESULTS: With contrast enhancement significantly better arterial signals were seen in 20 of 31 sonograms for the hepatic portal, in 22 for the right lobe and in 26 for the left lobe. Better portal vein signals were obtained in 17 of 31 examinations for the right lobe and in 16 for the left lobe; only little improvement was obtained for the main stem of the portal vein. For the hepatic veins there was no significant improvement. CONCLUSIONS: Early vascular complications after liver transplantation usually occur in the hepatic arteries. With the use of contrast-enhanced colour Doppler sonography, better detection of arterial and peripheral portal signals can be achieved; peripheral portal vein branches can be helpful in finding small arteries.