TIPSS-Kontrolle mit Farbduplexsonographie unter Anwendung eines Ultraschallverstärkungsmittels

Abstract

A study was performed to determine the visualization of the transjugular intrahepatic portosystemic stent shunt (TIPSS) and the detection of stenosis by the use of a capillary transversing signal enhancer. In 37 patients 37 colour-coded duplex sonographies were performed before and after intravenous injection of the ultrasound signal enhancer Levovist (Schering, Berlin). The examinations were evaluated using a four-category score. Special attention was paid to the detection of stenoses in the TIPSS. Transjugular portal venograms of the same day were used as gold standard. The use of Levovist provided better colour and flow signals for the portal vein end of the shunt in only 9 of 37 sonograms and for the hepatic vein end of the shunt in 37 of 39 sonograms. Eleven of 13 stenoses requiring reintervention in portal venography could be correctly identified with signal enhancer. Eleven of these 13 stenoses were located in the hepatic vein end of the shunt. Ultrasound signal enhancer can significantly improve the sonomorphological visualization especially of the hepatic vein end of TIPSS in colour-coded duplex sonography. Stenoses which usually occur in the hepatic vein end of the shunt may be better detected.

Der Stellenwert der Magnetresonanztomographie (MRT) für die Verlaufskontrolle bei Patienten mit transjugulärem intrahepatischem portosystemischem Stent-Shunt (TIPSS)

“…Mögliche Verbesserungen bieten hier der Einsatz der Power Dopplersonographie sowie die Verwendung von Ultraschallkontrastmitteln, die die Sensitivität und Spezifität der Diagnose einer Shunt-Dysfunktion signifikant erhöhen sollen [25,29]. Weiterhin kann die Interobserver-Variabilität der dopplersonographischen Flussmessung durch ein gemeinsames Trainingsprogramm reduziert werden [24].…”