Value Of Conventional Ultrasound, Contrast-enhanced Ultrasound And Shear Wave Elastography In Monitoring The Efficacy Of Transjugular Intrahepatic Portosystemic Shunt For Portal Hypertension

Objective: The aim of this study is to access the feasibility of those parameters measured with three ultrasound techniques,namely conventional ultrasound,contrast-enhanced ultrasound(CEUS),and shear wave elastography(SWE),in monitoring the efficiency of transjugular intrahepatic portosystemic shunt(TIPS).Methods: Thirty-four patients who underwent TIPS for treatment of Cirrhotic portal hypertension were included in this study.The portosystemic pressure gradient(PPG)of intraoperative measurement was used as the gold standard for analysis.Characteristic parameters of conventional ultrasound,CEUS and SWE techniques,were measured before and after TIPS,and the difference between the parameters pre and post TIPS will be compared and the correlation with PPG will be explored.The characteristic parameters selected in the current study include: 1)for conventional ultrasonic,portal vein diameter(PVD),portal vein velocity(PVV),splenic vein diameter(SVD),splenic vein velocity(SVV),superior mesenteric vein diameter(SMVD),superior mesenteric vein velocity(SMVV),and spleen thickness;2)for CEUS,arrival time(AT),time to peak(TTP),peak intensity(PI),ascending branch slope(AS),and area under curve(AUC);3)for SWE,liver shear wave velocity(SWV),and spleen SWV.Results: PPG of pre and post TIPS was(32.09�6.40)mm Hg and(15.77�6.07)mm Hg with statistical significance(P(27)0.05).As for conventional ultrasound,parameters post TIPS such as PVD and SVD decreased slightly,while PVV,SVV and SMVV post-TIPS significantly reduced,spleen thickness post-TIPS also decreased significantly,and they were all with statistical significance(P(27)0.05);no significant difference was found in SMVD pre and post TIPS.As for CEUS,the quantitative parameter AT of CEUS post TIPS had no significant difference(P(29)0.05);however,with statistically significant(P<0.05),the TTP post-TIPS decreased significantly,PK,AS and AUC post-TIPS increased significantly.The liver SWV pre and post TIPS was no significant difference.The spleen SWV post-TIPS was significantly reduced(P<0.05).The correlation with PPG is established in the following.Conventional ultrasound parameters such as PVV,SVV and SMVV were correlated with PPG(r=-0.533,r=-0.490,r=-0.493,all P<0.05);PVD,SVD,SMVD and spleen thickness were not correlated with PPG(r=0.237,r=0.068,r=0.152,r=0.152,all P>0.05).The quantitative parameters of CEUS(TTP,PK,AS and AUC)were correlated with PPG(r=0.396;r=-0.418;r=-0.471;r=-0.371,all P<0.05),while AT was not correlated with PPG(r=0.071,P>0.05).The spleen SWV was correlated with PPG(r=0.433,P<0.05),while the liver SWV was not correlated with PPG(r=0.036,P>0.05).Conclusion: The conventional ultrasound parameters such as PVV,SVV,SMVV;CEUS parameters such as TTP,PK,AS,AUC;and SWE parameter spleen SWV can be used to monitor the changes of portal vein pressure pre and post TIPS treatment,and this can be used as an important method for short-term efficacy monitoring and long-term follow-up after TIPS.