Shear Wave Elastography of the Spleen for Monitoring Transjugular Intrahepatic Portosystemic Shunt Function

Abstract

A Pilot Studyhe transjugular intrahepatic portosystemic shunt (TIPS) is used for management of refractory acute variceal hemorrhage and intractable ascites in late-stage liver diseases with portal hypertension. 1 In addition to monitoring the clinical status, it is important to monitor TIPS hemodynamic function objectively. 2,3 Although the portosystemic pressure gradient (PPG) and hepatic venous pressure gradient are still considered the reference standards for diagnosis and monitoring of portal hypertension, they Jing Gao, MD, Xiao Zheng, MS, Yuan-Yi Zheng, MD, Guo-Qing Zuo, MD, Hai-Tao Ran, MD, Yong Ho Auh, MD, Levi Waldron, PhD, Tiffany Chan, MS, Zhi-Gang Wang, MD Received July 6, 2015, Objectives-To assess the feasibility of splenic shear wave elastography in monitoring transjugular intrahepatic portosystemic shunt (TIPS) function.Methods-We measured splenic shear wave velocity (SWV), main portal vein velocity (PVV), and splenic vein velocity (SVV) in 33 patients 1 day before and 3 days to 12 months after TIPS placement. We also measured PVV, SVV, and SWV in 10 of 33 patients with TIPS dysfunction 1 day before and 3 to 6 days after TIPS revision. Analyses included differences in portosystemic pressure gradient (PPG), PVV, SVV, and mean SWV before and after TIPS procedures; comparison of median SWV before and after TIPS procedures; differences in PVV, SVV, and SWV before and at different times up to 12 months after TIPS placement; accuracy of PVV, SVV, and SWV in determining TIPS dysfunction; and correlation between PPG and SWV.Results-During 12 months of follow-up, 23 of 33 patients had functioning TIPS, and 10 had TIPS dysfunction. The median SWV was significantly different before and after primary TIPS placement (3.60 versus 3.05 m/s; P = .005), as well as before and after revision (3.73 versus 3.06 m/s; P = .003). The PPG, PVV, and SVV were also significantly different before and after TIPS placement and revision (P < .001). The PPG and SWV decreased, whereas PVV and SVV increased, after successful TIPS procedures. A positive correlation was observed between PPG and SWV (r = 0.70; P < .001), and a negative correlation was observed between PPG and PVV and SVV (r = -0.65; P < .001). The areas under the receiver operating characteristic curve for PVV, SVV, and SWV in determining TIPS dysfunction were 0.82, 0.84, and 0.81, respectively.Conclusions-Splenic SWV is compatible with splenoportal venous velocity in quantitatively monitoring TIPS function and determining TIPS dysfunction.

Modification of splenic stiffness on acoustic radiation force impulse parallels the variation of portal pressure induced by transjugular intrahepatic portosystemic shunt

“…The increase in SS after the reduction of the stent diameter observed in the two patients with persistent hepatic encephalopathy suggests that in patients submitted to TIPS, this parameter may be used to monitor the shunt function, confirming the observation of Gao et al 35 However, the efficacy and the sensitivity of splenic stiffness in detecting the occurrence of a shunt dysfunction after TIPS needs further investigations.…”

Increase in liver stiffness after transjugular intrahepatic portosystemic shunt is associated with inflammation and predicts mortality

“…(9)(10)(11)(12)(13)(14)(15) While it has been shown that liver and spleen stiffness might detect changes in hepatic venous pressure gradient after nonselective beta-blockers, the data were not as conclusive after TIPS. (16)(17)(18)(19) Importantly, a larger recent study could not sufficiently explain the reason behind the change of liver stiffness after TIPS. (20) This is probably due to the fact that liver stiffness is a result of various different factors, especially blood (arterial and venous) pressure, inflammation, and fibrosis.…”

“…Liver stiffness, measured by either transient elastography (TE)—recently approved by the Food and Drug Administration in the United States—or shear wave elastography (SWE), is a useful parameter in the diagnosis of clinically significant portal hypertension and varices requiring treatment . While it has been shown that liver and spleen stiffness might detect changes in hepatic venous pressure gradient after nonselective beta‐blockers, the data were not as conclusive after TIPS . Importantly, a larger recent study could not sufficiently explain the reason behind the change of liver stiffness after TIPS .…”

Clinical applications of spleen ultrasound elastography – a review

“…Other authors suggest that Transient Elastography is a user-friendly approach to the evaluation of spleen stiffness in primary myelofibrosis patients as a marker of the bone marrow fibrosis status and as a means of monitoring their response to innovative myelofibrosis therapies ( 40 ) . Another example of spleen elastography utilization is monitoring of transjugular intrahepatic portosystemic shunt (TIPS) function; it has been proven that splenic SWV is compatible with splenoportal venous velocity in the quantitative monitoring of the TIPS function and in determining TIPS dysfunction ( 41 ) .…”