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Radiology, Vol 189, 789-793, Copyright © 1993 by Radiological Society of North America

ARTICLES

Transjugular intrahepatic portosystemic shunt: US assessment with maximum flow velocity

WK Chong, TA Malisch, MJ Mazer, CD Lind, JA Worrell and WO Richards
Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN 37232-2675.

PURPOSE: To evaluate the ability of Doppler ultrasonography (US) to depict the patency of a transjugular intrahepatic portosystemic shunt (TIPS). MATERIALS AND METHODS: Twenty-eight patients were followed up after creation of TIPS with US, angiography, and endoscopy performed at regular intervals. Magnetic resonance (MR) angiography was performed in four patients. US was performed first, and the results were correlated with those at angiography. Measurements of maximum flow velocity (Vmax) were taken from the proximal part of the shunt. RESULTS: In normal shunts, mean Vmax was 95 cm/sec. Shunt obstruction was seen in 12 cases: occlusion in four and stenosis in eight. All cases of occlusion were detected with US and appeared as absent flow within the shunt. There was one false-positive diagnosis of occlusion. All cases of stenosis resulted in reduced Vmax (mean, 32 cm/sec; P < .001). After successful revision in seven patients, Vmax rose to a mean of 122 cm/sec. Artifact from the metal stent prevented flow assessment with MR imaging. CONCLUSION: US can be performed to evaluate shunt status, and Vmax is an accurate noninvasive parameter for assessing shunt patency.


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