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Evaluation of Doppler-ultrasonography in the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction: A prospective study

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World Journal of Hepatology 2017年第27期9卷 1125-1132页

作者： Charlotte Nicolas Amelie Le Gouge Louis d’Alteroche Jean Ayoub Monica Georgescu Vincent Vidal Denis Castaing Jean-Pierre Cercueil Patrick Chevallier Jerome Roumy Herve Trillaud Louis Boyer Vincent Le Pennec Christophe Perret bruno giraudeau Jean-Marc Perarnau STIC-TIPS group Service d’Hepato-Gastroenterologie Hopital TrousseauCHRU Tours CIC CHRU de Tours INSERM United’echographie-doppler Hopital TrousseauCHRU Tours Service de Radiologie Hopital de la Timone Centre Hepato-Biliaire Hopital Paul Brousse Service de Radiologie CHRU Dijon Service d’Imagerie Medicale Diagnostique et interventionnelle Hopital de l’ArchetⅡNice Service de Radiologie et Echographie CHRU Poitiers Service d’Imagerie Medicale Hopital Saint Andre CHRU Bordeaux Service d’Imagerie viscerale et vasculaire CHRU Clermont Ferrand Service de Radiologie CHRU Caen Service de Radiologie CHRU Nantes 不详

AIM To prospectively evaluate the performance of Dopplerultrasonography(US) for the detection of transjugular intrahepatic portosystemic shunt(TIPS) dysfunction within a multicenter cohort of cirrhotic *** This study was conducted in 10 french teaching hospitals. After TIPS insertion, angiography and liver Doppler-US were carried out every six months to detect dysfunction(defined by a portosystemic gradient ≥ 12 mm Hg and/or a stent stenosis ≥ 50%). The association between ultrasonographic signs and dysfunction was studied by logistic random-effects models, and the diagnostic performance of each Doppler criterion was estimated by the bootstrap method. This study was approved by the ethics committee of *** Two hundred and eighteen pairs of examinations performed on 87 cirrhotic patients were analyzed. Variables significantly associated with dysfunction were: The speed of flow in the portal vein(P = 0.008), the reversal of flow in the right(P = 0.038) and left(P = 0.049) portal branch, the loss of modulation of portal flow by the right atrium(P = 0.0005), ascites(P = 0.001) and the overall impression of the operator(P = 0.0001). The diagnostic performances of these variables were low; sensitivity was < 58% and negative predictive value was < 73%. Therefore, dysfunction cannot be ruled out from Doppler-US. CONCLUSION The performance of Doppler-US for the detection of TIPS dysfunction is poor compared to angiography. New tools are needed to improve diagnosis of TIPS dysfunction.

关键词： Transjugular intrahepatic portosystemic shunt Dysfunction Doppler-ultrasonography

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