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Transjugular Intrahepatic Portosystemic Shunts (TIPS)

Effects of Respiratory State and Patient Position on the Measurement of Doppler Velocities

Mark A. Kliewer1, Barbara S. Hertzberg, Joan P. Heneghan, Paul V. Suhocki, Douglas H. Sheafor, Peter A. Gannon, Jr. and Erik K. Paulson

1 All authors: Department of Radiology, Duke University Medical Center, Box 3808, Rm. 2526, Blue Zone South, Durham, NC 27710.



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  		Fig. 1A. —64-year-old woman with cirrhosis and chronic hepatitis C infection. Spectral Doppler tracing in mid transjugular intrahepatic portosystemic shunt reveals peak systolic velocity of 104.7 cm/sec. Patient was supine and in quiet respiration.

 


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  		Fig. 1B. —64-year-old woman with cirrhosis and chronic hepatitis C infection. Spectral Doppler tracing at same site as A with patient supine and in deep inspiration shows Doppler velocity of 80.8 cm/sec.

 


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  		Fig. 2A. —58-year-old woman with decompensated chronic liver disease caused by primary biliary cirrhosis. Longitudinal Doppler sonogram with spectral wave-form obtained from mid shunt shows peak velocity of 71.8 cm/sec. Patient was upright and quietly breathing.

 


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  		Fig. 2B. —58-year-old woman with decompensated chronic liver disease caused by primary biliary cirrhosis. Doppler sonogram obtained at same site as A with patient upright and in deep inspiration reveals measured velocity in shunt of 45.5 cm/sec, which is less than all reported ranges of normal velocities for transjugular intrahepatic portosystemic shunt.

 

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