AIM To prospectivel. eval.ate the performance of Doppl.rul.rasonography(US) for the detection of transjugul.r intrahepatic portosystemic shunt(TIPS) dysfunction within a mul.icenter cohort of cirrhotic *** This study ...
详细信息
AIM To prospectivel. eval.ate the performance of Doppl.rul.rasonography(US) for the detection of transjugul.r intrahepatic portosystemic shunt(TIPS) dysfunction within a mul.icenter cohort of cirrhotic *** This study was conducted in 10 french teaching hospital.. After TIPS insertion, angiography and l.ver Doppl.r-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 ul.rasonographic signs and dysfunction was studied by l.gistic random-effects model., and the diagnostic performance of each Doppl.r 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 anal.zed. Variabl.s significantl. associated with dysfunction were: The speed of fl.w in the portal.vein(P = 0.008), the reversal.of fl.w in the right(P = 0.038) and l.ft(P = 0.049) portal.branch, the l.ss of modul.tion of portal.fl.w by the right atrium(P = 0.0005), ascites(P = 0.001) and the overal. impression of the operator(P = 0.0001). The diagnostic performances of these variabl.s were l.w; sensitivity was l.e was l.d out from Doppl.r-US. CONCl.SION The performance of Doppl.r-US for the detection of TIPS dysfunction is poor compared to angiography. New tool. are needed to improve diagnosis of TIPS dysfunction.
Objectives: To eval.ate mul.isl.ce computed tomography(MSCT) as an al.ernative to coronary angiography,we prospectivel. studied its diagnostic accuracy for the detection of significant coronary artery l.sions in patie...
详细信息
Objectives: To eval.ate mul.isl.ce computed tomography(MSCT) as an al.ernative to coronary angiography,we prospectivel. studied its diagnostic accuracy for the detection of significant coronary artery l.sions in patients with significant aortic val.e stenosis undergoing val.e surgery. Background: In patients with aortic val.e stenosis, coronary angiography is stil. recommended before surgery. Mul.isl.ce computed tomography is a promising noninvasive technique for the detection of significant coronary artery l.sions. Methods: Fifty-five consecutive patients schedul.d for coronary angiography in the preoperative assessment of aortic val.e stenosis underwent 16-sl.ce MSCT 24 h before coronary angiography. We anal.zed coronary l.sions, image qual.ty, and arterial.cal.ium score. Resul.s: The sensitivity of the MSCT-based strategy in detecting significant stenosis was 100%, and its specificity 80%. The positive and negative predictive val.es were respectivel. 55%and 100%. For cal.ium scoresl. patients without coronary artery disease, enabl.ng conventional.coronary angiography to be avoided in 35 of 55 cases(80%). For cal.ium scores >1,000, MSCT enabl.d conventional.coronary angiography to be avoided in onl. 6%of cases, either because significant stenosis was found with a possibl. indication of revascul.rization, or because the examination was not interpretabl.. Concl.sions: The resul.s of this initial.experience in rel.tivel. few patients suggest that MSCT-based coronary angiography may serve as an al.ernative to invasive coronary angiography to rul. out significant coronary artery disease in patients schedul.d for el.ctive aortic val.e repl.cement. l.rger studies are necessary to ful.y expl.re the potential.of coronary MSCT to improve preoperative risk stratification.
暂无评论