Twenty-three patients with biochemically proved Wilson disease underwent magnetic resonance (MR) imaging of the brain. Positive findings, believed secondary to this condition, were found in 15 subjects. Findings varied among patients, but there were striking similarities between certain groups of patients. Areas of abnormal signal were seen in the lenticular, thalamic, caudate, and dentate nuclei, as well as in the brain stem; in these areas, the abnormalities were bilaterally symmetric. A smaller number of patients had asymmetric focal white-matter lesions. Correlation of the MR findings with clinical symptoms was generally good. Repeat imaging was performed on five patients at intervals ranging from 4 to 8 months; none showed significant interval change.
Background
The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal vein thrombosis (PVT) remains controversial. This study aimed to conduct a systematic review and meta-analysis to evaluate the role of TIPS for the management of PVT in adult patients with liver disease.
Patients and methods
Multiple databases were searched through April 2017. Data were gathered to estimate the rates of technical success, portal vein recanalization, portal patency, hepatic encephalopathy, and mean change in portal pressure gradient in patients with PVT who underwent TIPS. Estimates were pooled across studies using the random effects model.
Results
Eighteen studies were included in the analysis. The pooled technical success rate was 86.7% [95% confidence interval (CI)=78.6–92.1%]. Rate of portal vein recanalization was 84.4% (95% CI=78.4–89.0%). The rate of complete recanalization was 73.7% (95% CI=64.3–81.3%). Portal patency was 86.9% (95% CI=79.7–91.8%). Mean change in portal pressure gradient was 14.5 mmHg (95% CI=11.3–17.7 mmHg). Hepatic encephalopathy was 25.3% (95% CI=19.2–32.6%). The number of major adverse events reported across studies was low. The majority of the analyses were not associated with substantial heterogeneity.
Conclusion
The use of TIPS in the management of PVT is feasible and effective in achieving a significant and sustainable reduction in clot burden with a low risk of major complications. TIPS should be considered as a viable treatment option in patients with PVT. Given the limited amount of randomized comparative studies reported, additional trials are warranted to assess the safety and efficacy of TIPS as a treatment modality in PVT, in comparison to other treatment options, such as anticoagulation.
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