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Effects of TIPS on Liver Perfusion Measured by Dynamic CT

¹ Department of Radiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna A-1090, Austria.
² Department of Internal Medicine IV, Gastroenterology and Hepatology, University of Vienna, Austria.

View larger version (122K): [in a new window]   Fig. 1A. —Representative scans obtained at level that includes liver, spleen, aorta, and portal vein in a 51-year-old woman with cirrhosis before transjugular intrahepatic portosystemic shunt placement. Regions of interest are drawn over liver, spleen, aorta (long arrow), and portal vein (short arrow). Inhomogeneous enhancement pattern of spleen (B and C) is normal finding at arterial phase and early portal venous phase and is caused by rapid injection of bolus contrast agent. Dynamic single-section CT scan represents unenhanced baseline (first scan).

View larger version (124K): [in a new window]   Fig. 1B. —Representative scans obtained at level that includes liver, spleen, aorta, and portal vein in a 51-year-old woman with cirrhosis before transjugular intrahepatic portosystemic shunt placement. Regions of interest are drawn over liver, spleen, aorta (long arrow), and portal vein (short arrow). Inhomogeneous enhancement pattern of spleen (B and C) is normal finding at arterial phase and early portal venous phase and is caused by rapid injection of bolus contrast agent. Dynamic single-section arterial phase CT scan shows that aorta (long arrow), branches of hepatic artery (arrowhead), and splenic artery (curved arrow) are enhanced during hepatic arterial phase. Portal vein (short arrow) is not enhanced as result of early phase.

View larger version (127K): [in a new window]   Fig. 1C. —Representative scans obtained at level that includes liver, spleen, aorta, and portal vein in a 51-year-old woman with cirrhosis before transjugular intrahepatic portosystemic shunt placement. Regions of interest are drawn over liver, spleen, aorta (long arrow), and portal vein (short arrow). Inhomogeneous enhancement pattern of spleen (B and C) is normal finding at arterial phase and early portal venous phase and is caused by rapid injection of bolus contrast agent. Dynamic single-section portal venous phase CT scan shows that portal vein (short arrow) and splenic vein (open arrowhead) are enhanced during portal venous phase. Contrast enhancement of aorta (long arrow) is declining.

View larger version (127K): [in a new window]   Fig. 2A. —Representative scans of dynamic single-section CT series in a 50-year-old man with cirrhosis after transjugular intrahepatic portosystemic shunt (TIPS) placement. On hepatic arterial phase scan, section was chosen just below TIPS; therefore, stent is not imaged. Aorta (long arrow), branches of hepatic artery (arrowhead), and splenic artery (curved arrow) are enhanced during hepatic arterial phase. Portal vein (short arrow) is not enhanced as result of early phase. Inhomogeneous enhancement of spleen is normal finding caused by high injection rates of contrast material.

View larger version (135K): [in a new window]   Fig. 2B. —Representative scans of dynamic single-section CT series in a 50-year-old man with cirrhosis after transjugular intrahepatic portosystemic shunt (TIPS) placement. On portal venous phase scan, because of respiration, inferior end of TIPS stent (open arrow) is depicted in imaging plane but does not interfere with either exact density measurement of parenchyma or portal vein. Portal vein (short arrow) and splenic vein (open arrowhead) are enhanced during portal venous phase.

View larger version (10K): [in a new window]   Fig. 3. —Graph shows mean arterial, portal venous, and total perfusion values of hepatic parenchyma (milliliters per minute per 100 mL of tissue) between patients with cirrhosis (n = 24, white bars) before transjugular intrahepatic portosystemic shunt placement and healthy patients (controls) (n = 41, black bars). There were statistically significant differences for arterial and portal venous component and for total perfusion of hepatic parenchyma (p < 0.05 [single asterisk], p < 0.01 [double asterisks]).

View larger version (10K): [in a new window]   Fig. 4. —Graph shows mean arterial, portal venous, and total perfusion values of hepatic parenchyma (milliliters per minute per 100 mL of tissue) of 17 patients before (black bars) and after (white bars) transjugular intrahepatic portosystemic shunt placement (p = 0.011 [single asterisk], p < 0.01 [double asterisks]).

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