Covered transjugular intrahepatic portosystemic shunts: accuracy of ultrasound in detecting shunt malfunction.

Journal Article

OBJECTIVE: The purpose of this study was to determine the accuracy of ultrasound for detecting transjugular intrahepatic portosystemic shunt (TIPS) malfunction in covered stents in comparison with bare metal stents. MATERIALS AND METHODS: During a 6-year period, 126 TIPS angiography examinations were performed in 78 patients who had undergone a recent TIPS ultrasound examination. Radiology reports and images were retrospectively reviewed, and the sensitivity and specificity of sonographic parameters for detecting TIPS dysfunction were calculated using TIPS angiography and portosystemic gradient as the reference standards. RESULTS: Of 126 paired studies, 43 were in bare metal TIPS and 83 were in covered TIPS. Peak shunt velocity of covered and bare metal TIPS measured by ultrasound showed comparable sensitivities for detection of shunt dysfunction, using both depressed (< 90 cm/s) and elevated (> 200 cm/s) peak shunt velocity criteria. However, a depressed velocity was more specific in covered TIPS (0.939 vs 0.550, p < 0.001) whereas elevated velocity was more specific in bare TIPS (0.485 vs 0.800, p = 0.041). An interval change in peak TIPS velocity greater than 25% was significantly more sensitive in detection of dysfunction in covered TIPS (0.815 vs 0.400, p = 0.015) whereas detection based on main portal vein velocities (≤ 30 cm/s) was not statistically different in the two groups. CONCLUSION: Our data suggest that the accuracy of ultrasound for detection of TIPS shunt malfunction is at least as high in covered stents as in bare metal stents. Diagnostic performance for several sonographic parameters varied significantly between bare and covered stents, suggesting the need for optimization of sonographic criteria for covered stents.

Full Text

Duke Authors

Cited Authors

  • Engstrom, BI; Horvath, JJ; Suhocki, PV; Smith, AD; Hertzberg, BS; Smith, TP; Kim, CY

Published Date

  • April 2013

Published In

Volume / Issue

  • 200 / 4

Start / End Page

  • 904 - 908

PubMed ID

  • 23521468

Electronic International Standard Serial Number (EISSN)

  • 1546-3141

Digital Object Identifier (DOI)

  • 10.2214/AJR.12.8761

Language

  • eng

Conference Location

  • United States