Diagnostic Value Of Conventional Ultrasound In Detecting Transjugular Intrahepatic Portosystemic Shunt Dysfunction

PART 1 Diagnostic value of conventional ultrasound in detecting transjugular intrahepatic portosystemic shunt dysfunctionObjective To evaluate the role of ultrasound in the detection of shunt dysfunction in patients with transjugular intrahepatic portosystemic shunt(TIPS).Methods Thirty-three(35 times)patients were ultrasound and/or clinically suspected of having shunt dysfunction,who underwent conventional ultrasound and the portography were retrospectively studied.The ultrasound study included evaluating the presence of color flow signal within the shunt,the peak velocity in the shunt and in the main portal vein(PV),the diameter of PV,the flow direction of sagittal part of portal vein after the procedure.We compared the ultrasound parameters between TIPS normal and dysfunction time point,and the performance of ultrasound for the detection of TIPS dysfunction assessed by portography.Results There were 35 cases of TIPS dysfunction with conventional ultrasound diagnostic rate of 100%(35/35).Of them,19 cases were stenosis and the rest 16 cases were occlusion,with conventional ultrasound diagnostic rate of 89.5%(17/19)and 93.8%(15/16).In 35 ultrasonography,the hepatofugal flow of the sagittal part of portal vein was detected in 21 of 35 cases(60.0%)in TIPS normal time pointand in 2 of 35 cases(5.7%)in TIPS dysfunction time point.In TIPS dysfunction time point,the peak velocity(26.02 ± 8.49 cm/s)and flow(1563.38 ± 529.82 ml/min)within the PV were significantly lower,but the diameter(1.49 ± 0.10 cm)was not statistically significant,and congestion index(0.14 ± 0.08)of PV were significantly higher.Conclusions Take the portography as the reference standard,the accuracies of diagnosing TIPS dysfunction with conventional ultrasound is higher in our analysis.Conventional ultrasound can be used as the first choice for clinical follow-up examination after TIPS procedures.PART 2 Diagnostic value of conventional ultrasound and shear wave elastography in detecting transjugular intrahepatic portosystemic shunt dysfunctionObjective To assess the clinical value of conventional ultrasound in combination with point shear wave elastography(p SWE)to predict transjugular intrahepatic portosystemic shunt(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 by conventional ultrasound and p SWE.Outcome measures included differences in portal vein velocity(PVV),splenic vein velocity(SPVV),LS,and SPS.Analyses included differences in portal vein peak velocity(PVV),portal vein diameter(PVD),splenic vein peak velocity(SPVV),splenic vein diameter(SPVD),the 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 the 184 patients(15.2%).Eighteen(64.3%)patients had shunt stenoses,and 10(35.7 %)had shunt occlusion.Twenty two of 28(78.5%)patients were symptomatic,with 19/22(86.4%)having recurrent or persistent ascites,and 7/22(31.8%)suffering from recurrent variceal bleeding.PVD,PVV,SPVD,SPVV,LS,and SPS were not significantly different between the TIPS normal and TIPS dysfunction groups.Compared with the TIPS normal group,PVV(54.68 ± 8.74 VS 33.28 ± 5.94 cm/s)and SPVV(47.21 ± 6.73 VS 32.41 ± 4.79 cm/s)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: p SWE showed a diagnostic efficacy comparable to conventional ultrasound for diagnosing TIPS dysfunction and can be used routinely after TIPS procedures.