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

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.

Does advanced cirrhosis with portosystemic shunting affect the value of CT arterial portography in the evaluation of the liver?

OBJECTIVE: The purpose of this study was to determine the extent to which reduced portal blood flow in patients with advanced cirrhosis affects contrast enhancement of the liver during CT arterial portography (CTAP). We postulated that reduced and/or irregular hepatic enhancement would limit the efficacy of CTAP for the detection of hepatic tumors in these patients. MATERIALS AND METHODS: We reviewed the records of 82 patients who had biopsy-proved advanced cirrhosis and who underwent CTAP. Three experienced radiologists evaluated the CTAP studies for adequacy of hepatic parenchymal enhancement. The presence or absence of varices also was documented in an attempt to select a subgroup of patients in whom CTAP showed better hepatic parenchymal enhancement. RESULTS: Forty-seven (57%) of 82 patients had inadequate hepatic parenchymal enhancement to allow an evaluation of the entire liver. Inadequacy was attributable to areas of hyperdense parenchymal enhancement, areas of diffuse nontumoral mottling, or zones of poor parenchymal enhancement (soft-tissue attenuation equal to that of the paraspinal muscle). Parenchymal enhancement was inadequate in 62% of patients with varices and in 28% of patients without demonstrable varices. CONCLUSION: Our results show that contrast enhancement of the liver during CTAP is altered significantly in patients with cirrhosis. Thus, it is likely that CTAP has limited usefulness for the detection or characterization of hepatic neoplasms in patients with cirrhosis.