MR Evaluation of Portal Hypertensive Collateral Shunting Vessels for Predicting Outcome after Transjugular Intrahepatic Portosystemic Shunt

Abstract

Purpose: We assessed whether magnetic resonance (MR) imaging evaluation of portosystemic collateral shunts can aid prediction of therapeutic eŠectiveness and complications after creation of a transjugular portosystemic shunt (TIPS), and technical di‹culty during the TIPS procedure.Materials and Methods: We retrospectively reviewed 32 patients (27 men, 5 women; mean age, 56.4 years) who underwent TIPS creation following gadolinium-enhanced MR examination. We measured the diameters of pre-existing portosystemic collateral shunting vessels, added the measurements together to generate a shunting collateral score for each patient, and divided patients into 2 groups by score of 4 or greater or less than 4. We then compared therapeutic eŠectiveness, technical di‹culty and complications of the TIPS procedure, and portal venous (PV) pressure, PV-inferior vena cava (IVC) pressure gradient, and PV diameter between the groups.Results: The patients with a pre-existing large portosystemic shunt showed insigniˆcant trends toward higher technical di‹culty of the shunt procedure and rate of shunt dysfunction. The 2 groups showed no signiˆcant diŠerence in early mortality rate, onset or worsening rate of hepatic encephalopathy after TIPS creation, PV pressure, PV-IVC pressure gradient, or PV diameter.Conclusion: Gadolinium-enhanced MR imaging may help in predicting technical di‹-culty and complications of TIPS.

The Effect of Hepatic Encephalopathy, Hepatic Failure, and Portosystemic Shunt on Brain Volume of Cirrhotic Patients: A Voxel-Based Morphometry Study

“…Reconstructed data were transferred from the scanner to a 3D workstation (Multi Modality Workplace; Siemens Medical Solutions, Erlangen, Germany). The two abdominal radiologists (with 10 years experience in reading abdominal CT images) graded each PS collateral by consensus using a scale system considering total area of shunting collaterals proposed by Yoshikawa et al [13]. Severity was evaluated using a sum of the scores, referred to as shunting collateral score.…”

Clinical Outcome Using the Fluency Stent Graft for Transjugular Intrahepatic Portosystemic Shunt in Patients with Portal Hypertension

“…There was a large amount of extrahepatic shunt of portal blood flow in patients with large-diameter varicose. 11 The shunt with 8 mm diameter is not large enough to achieve the required portosystemic pressure gradient to prevent the bleeding of serious varicose with large diameter. However, liver function will be impaired if the shunt diameter is enlarged.…”