HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zizka, J. Articles by Bukac, J. Search for Related Content PubMed PubMed Citation Articles by Zizka, J. Articles by Bukac, J. Social Bookmarking                      What's this?

Value of Doppler Sonography in Revealing Transjugular Intrahepatic Portosystemic Shunt Malfunction

A 5-Year Experience in 216 Patients

Jan ika¹, Pavel Eliá¹, Antonín Krajina¹, Antonín Michl¹, Miroslav Lojík¹, Pavel Ryka¹, Jana Maková¹, Petr Hlek², Václav afka², Tomá Vaásek² and Josef Buka³

¹ Department of Diagnostic Radiology, Charles University Hospital, Sokolská 408, CZ-500 05 Hradec Králové, Czech Republic.
² Department of Internal Medicine, Charles University Hospital, CZ-500 05 Hradec Králové, Czech Republic.
³ Department of Biophysics, Medical Faculty, Charles University, CZ-500 38 Hradec Králové, Czech Republic.

View larger version (80K): [in a new window]   Fig. 1. —50-year-old man with liver cirrhosis. Transjugular intrahepatic portosystemic shunt was implanted 9 months earlier. Color-assisted duplex sonogram shows maximum velocity (Vmax) measurement in portal vein (Vmax = 47 cm/sec). High velocity in portal vein and almost no temporal change from baseline value (50 cm/sec) suggest good shunt patency.

View larger version (61K): [in a new window]   Fig. 2. —67-year-old woman with liver cirrhosis. Transjugular intrahepatic portosystemic shunt was created 4 years earlier. Color-assisted duplex sonogram reveals abnormally low maximum velocity (Vmax) in portal third of shunt (Vmax = 27 cm/sec). Significant stenosis was expected in outflow tract; however, acoustic conditions prevented its direct sonographic visualization. Indicated shunt venography revealed short, tight stenosis of hepatic vein (not shown).

View larger version (62K): [in a new window]   Fig. 3A. —49-year-old woman with liver cirrhosis. Transjugular intrahepatic portosystemic shunt was created 6 months earlier. Color Doppler sonogram reveals region of color aliasing in mid portion of diffusely stenosed shunt.

View larger version (131K): [in a new window]   Fig. 3B. —49-year-old woman with liver cirrhosis. Transjugular intrahepatic portosystemic shunt was created 6 months earlier. Spectral Doppler measurement shows maximum velocity increase up to 420 cm/sec in region of color aliasing.

View larger version (172K): [in a new window]   Fig. 3C. —49-year-old woman with liver cirrhosis. Transjugular intrahepatic portosystemic shunt was created 6 months earlier. Angiogram confirms diffuse shunt stenosis, which was accentuated in mid portion of shunt and presented as radiolucency with poststenotic dilatation.

View larger version (15K): [in a new window]   Fig. 4. —Graph shows flow volume in main portal vein for baseline and prerevision sonograms. Note significant decrease of flow volume in malfunctioning shunts. Bottom and top of rectangular boxes are 25th and 75th percentiles, length of box represents interquartile range (IQR) and contains 50% of data. Central line in box is median (50th percentile). Lower (or upper) adjacent value displayed as T-shaped line represents largest observation that is equal to 25th percentile minus IQR (or 75th percentile plus IQR). Circles represent observations outside adjacent values. MPV = main portal vein.

View larger version (14K): [in a new window]   Fig. 5. —Graph shows maximum velocity in main portal vein for baseline and prerevision sonograms. Note significant decrease of maximum velocity in malfunctioning shunts. Bottom and top of rectangular boxes are 25th and 75th percentiles, length of box represents interquartile range (IQR) and contains 50% of data. Central line in box is median (50th percentile). Lower (or upper) adjacent value displayed as T-shaped line represents largest observation that is equal to 25th percentile minus IQR (or 75th percentile plus IQR). Circles represent observations outside adjacent values. MPV = main portal vein.

View larger version (14K): [in a new window]   Fig. 6. —Graph shows congestion index of main portal vein measured before and after transjugular intrahepatic portosystemic shunt (TIPS) creation. Note significant decrease of congestion index after TIPS creation. Bottom and top of rectangular boxes are 25th and 75th percentiles, length of box represents interquartile range (IQR) and contains 50% of data. Central line in box is median (50th percentile). Lower (or upper) adjacent value displayed as T-shaped line represents largest observation that is equal to 25th percentile minus IQR (or 75th percentile plus IQR). Circles represent observations outside adjacent values.

View larger version (13K): [in a new window]   Fig. 7. —Graph shows congestion index of main portal vein obtained from baseline and prerevision sonograms. Note significant increase of congestion index in malfunctioning shunts. Bottom and top of rectangular boxes are 25th and 75th percentiles, length of box represents interquartile range (IQR) and contains 50% of data. Central line in box is median (50th percentile). Lower (or upper) adjacent value displayed as T-shaped line represents largest observation that is equal to 25th percentile minus IQR (or 75th percentile plus IQR). Circles represent observations outside adjacent values.

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati