Volumetric Blood Flow in Transjugular Intrahepatic Portosystemic Shunt Revision Using 3‐Dimensional Doppler Sonography

Pintér, Š.; Rubin, Jonathan M.; Kripfgans, Oliver D.; Novelli, Paula M.; Vargas-Vila, Mario; Hall, Anne L.; Fowlkes, J. Brian

doi:10.7863/ultra.34.2.257

Cited by 23 publications

(18 citation statements)

References 40 publications

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“…Our observations on the use of 4D-flow MR imaging are concordant with those from a recent study on 4D Doppler US (15). These authors concluded that shunt volume measurements provide an alternative metric to quantify shunt function and that an increased shunt fraction corresponds to a decreased pressure gradient (15).…”

Section: Discussionsupporting

confidence: 90%

“…These authors concluded that shunt volume measurements provide an alternative metric to quantify shunt function and that an increased shunt fraction corresponds to a decreased pressure gradient (15). Future and larger studies are needed to determine whether the TIPS-to-PV flow ratio measured with 4D-flow MR imaging may be useful for predicting the risk for hepatic encephalopathy and refractory ascites and whether TIPS revision is needed due to in-stent stenosis or thrombosis.…”

Section: Discussionmentioning

confidence: 99%

“…The shunt fraction may be used to predict the risk for hepatic encephalopathy, refractory ascites, or variceal bleeding. Indeed, shunt volume flow measurements made at four-dimensional (4D) Doppler US have shown promise as indicators of shunt function (15). However, 4D Doppler US is also limited by operator dependency similar to that of conventional two-dimensional Doppler US (15).…”

mentioning

confidence: 99%

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Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging

Bannas¹,

Roldán‐Alzate²,

Johnson³

et al. 2016

Radiology

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Purpose To demonstrate the feasibility of four-dimensional (4D)– flow magnetic resonance (MR) imaging for noninvasive longitudinal hemodynamic monitoring of hepatic blood flow before and after transjugular intrahepatic portosystemic shunt (TIPS) placement. Materials and Methods The institutional review board approved this prospective Health Insurance Portability and Accountability Act compliant study with written informed consent. Four-dimensional–flow MR imaging was performed in seven patients with portal hypertension and refractory ascites before and 2 and 12 weeks after TIPS placement by using a time-resolved three-dimensional radial phase-contrast acquisition. Flow and peak velocity measurements were obtained in the superior mesenteric vein (SMV), splenic vein (SV), portal vein (PV), and the TIPS. Flow volumes and peak velocities in each vessel, as well as the ratio of in-stent to PV flow, were compared before and after TIPS placement by using analysis of variance. Results Flow volumes significantly increased in the SMV (0.24 L/ min; 95% confidence interval [CI]: 0.07, 0.41), SV (0.31 L/min; 95% CI: 0.07, 0.54), and PV (0.88 L/min; 95% CI: 0.06, 1.70) after TIPS placement (all P < .05), with no significant difference between the first and second post-TIPS placement acquisitions (all P > .11). Ascites resolved in six of seven patients. In those with resolved ascites, the TIPS-to-PV flow ratio was 0.8 ± 6 0.2 and 0.9 ± 0.2 at the two post-TIPS time points, respectively, while the observed ratios were 4.6 and 4.3 in the patient with refractory ascites at the two post-TIPS time points, respectively. In this patient, 4D-flow MR imaging demonstrated arterio-portal-venous shunting, with draining into the TIPS. Conclusion Four-dimensional–flow MR imaging is feasible for noninvasive longitudinal hemodynamic monitoring of hepatic blood flow before and after TIPS placement.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging

Bannas¹,

Roldán‐Alzate²,

Johnson³

et al. 2016

Radiology

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“…by custom algorithms implemented in MATLAB (The MathWorks, Natick, MA) through a user‐specified c‐surface by the method of surface integration of color flow–measured velocity vectors . Power mode data were used to correct for the partial volume effect …”

Section: Methodsmentioning

confidence: 99%

Evaluation of Umbilical Vein Blood Volume Flow in Preeclampsia by Angle‐Independent 3D Sonography

Pintér

Kripfgans

Treadwell

et al. 2017

J of Ultrasound Medicine

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Results indicate that mean depth-corrected, weight-normalized umbilical vein volume flow is reduced in pregnancies complicated by preeclampsia and that volume flow may indicate hypertensive disorder earlier in gestation. Volume flow measurements are highly reproducible, and further study in a larger clinical population is encouraged to determine whether 3D volume flow can complement the management of preeclampsia and, in general, at-risk pregnancy.

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“…Pinter [14] revealed that during TIPS, ultrasound can dynamically detect the position of the catheter head in real time, display surrounding vascular morphology and spatial location, reduce the blindness of puncture, and improve the success rate of puncture. However, these ultrasound findings were significantly affected by ascites and intestinal gas and operator proficiency.…”

Section: Ultrasoundmentioning

confidence: 99%

320-slice CT angiography before hepatic intrahepatic portosystemic shunt for evaluating the puncture approach

Ge¹,

Wang²,

Shao³

et al. 2018

biomedicalresearch

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Objective: This study aims to evaluate the value of 320 slice Computed Tomography Angiography (CTA) in evaluating puncture approaches by simulating Intrahepatic Portosystemic Shunt (IPS) in cirrhotic patients with portal hypertension. Methods: A total of 30 patients with hepatic cirrhosis and portal hypertension, who underwent IPS from November 2014 to January 2017 at Yunnan Province Second People's Hospital, were selected for this study. The CTA data acquired before surgery were retrospectively analysed. The puncture distances and puncture angles from the right hepatic vein, middle hepatic vein and left hepatic vein to the portal vein and its branches were measured and compared with those acquired by Digital Subtraction Angiography (DSA). Then, the differences between the puncture distances and angles acquired by CTA and DSA were evaluated. Results: Differences between puncture distances and angles acquired by CTA and DSA were not statistically significant (P>0.05). Conclusions: Puncture distances and angles acquired by CTA were consistent with those acquired by DSA. This can provide an imaging basis for the preoperative surgical planning of IPS.

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Volumetric Blood Flow in Transjugular Intrahepatic Portosystemic Shunt Revision Using 3‐Dimensional Doppler Sonography

Abstract: Shunt volume flow measurement with 3D/4D Doppler sonography provides a potential alternative to standard pulsed wave Doppler metrics as an indicator of shunt function and predictor of revision.

Cited by 23 publications

References 40 publications

Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging

Longitudinal Monitoring of Hepatic Blood Flow before and after TIPS by Using 4D-Flow MR Imaging

Evaluation of Umbilical Vein Blood Volume Flow in Preeclampsia by Angle‐Independent 3D Sonography

320-slice CT angiography before hepatic intrahepatic portosystemic shunt for evaluating the puncture approach

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