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Glückert K, Decker A, Meier JA, Nowak S, Sanoubara F, Gödiker J, Reinartz Groba SN, Kimmann M, Luetkens JA, Chang J, Sprinkart AM, Praktiknjo M. 3D-Volumetric Shunt Measurement for Detection of High-Risk Esophageal Varices in Liver Cirrhosis. J Clin Med 2024; 13:2678. [PMID: 38731206 PMCID: PMC11084829 DOI: 10.3390/jcm13092678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
Background and Objectives: Esophageal varices (EV) and variceal hemorrhages are major causes of mortality in liver cirrhosis patients. Detecting EVs early is crucial for effective management. Computed tomography (CT) scans, commonly performed for various liver-related indications, provide an opportunity for non-invasive EV assessment. However, previous CT studies focused on variceal diameter, neglecting the three-dimensional (3D) nature of varices and shunt vessels. This study aims to evaluate the potential of 3D volumetric shunt-vessel measurements from routine CT scans for detecting high-risk esophageal varices in portal hypertension. Methods: 3D volumetric measurements of esophageal varices were conducted using routine CT scans and compared to endoscopic variceal grading. Receiver operating characteristic (ROC) analyses were performed to determine the optimal cutoff value for identifying high-risk varices based on shunt volume. The study included 142 patients who underwent both esophagogastroduodenoscopy (EGD) and contrast-enhanced CT within six months. Results: The study established a cutoff value for identifying high-risk varices. The CT measurements exhibited a significant correlation with endoscopic EV grading (correlation coefficient r = 0.417, p < 0.001). A CT cutoff value of 2060 mm3 for variceal volume showed a sensitivity of 72.1% and a specificity of 65.5% for detecting high-risk varices during endoscopy. Conclusions: This study demonstrates the feasibility of opportunistically measuring variceal volumes from routine CT scans. CT volumetry for assessing EVs may have prognostic value, especially in cirrhosis patients who are not suitable candidates for endoscopy.
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Affiliation(s)
- Kathleen Glückert
- Department of Internal Medicine I, University Hospital Bonn, 53127 Bonn, Germany
| | - Alexandra Decker
- Department of Internal Medicine I, University Hospital Bonn, 53127 Bonn, Germany
| | - Jörn Arne Meier
- Department of Internal Medicine B, University Hospital Münster, 48149 Münster, Germany
| | - Sebastian Nowak
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Feras Sanoubara
- Department of Internal Medicine B, University Hospital Münster, 48149 Münster, Germany
| | - Juliana Gödiker
- Department of Internal Medicine B, University Hospital Münster, 48149 Münster, Germany
| | | | - Markus Kimmann
- Department of Internal Medicine B, University Hospital Münster, 48149 Münster, Germany
| | - Julian A. Luetkens
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Johannes Chang
- Department of Internal Medicine I, University Hospital Bonn, 53127 Bonn, Germany
| | - Alois M. Sprinkart
- Department of Diagnostic and Interventional Radiology, University Hospital Bonn, 53127 Bonn, Germany
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital Bonn, 53127 Bonn, Germany
- Department of Internal Medicine B, University Hospital Münster, 48149 Münster, Germany
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Strobel D, Agaimy A, Jesper D, Zundler S, Schellhaas B. HCCs lacking arterial phase hyperenhancement (APHE) on contrast-enhanced ultrasound (CEUS) - a diagnostic challenge. Findings from the prospective multicenter DEGUM CEUS HCC trial. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:606-613. [PMID: 36781161 DOI: 10.1055/a-2034-1911] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Hepatocellular carcinoma (HCC) upon contrast-enhanced ultrasound (CEUS) typically shows arterial phase hyperenhancement (APHE), followed by late (> 60 seconds) and mild contrast washout (WO). Although APHE is considered as the hallmark of HCC, it can be absent in some HCCs. Thus, we explored which sonomorphological and histopathological features of HCC are associated with a lack of APHE upon CEUS. METHODS Focal liver lesions in high-risk patients for HCC were assessed with CEUS following a standardized protocol in a prospective multi-center real-life setting. CEUS patterns in HCC were assessed, and tumour and patient characteristics were compared for HCCs with and without APHE. RESULTS 316 patients with HCC were recruited (cirrhosis, 76.9%). APHE occurred in 271/316 HCCs (85.8%). A lack of APHE was associated with portal vein thrombosis, tumour infiltration of the liver vessels (p<0.001), larger size, multilocularity, and higher depth location upon ultrasound (p<0.01). Histological grading did not differ between HCCs with and without APHE (p=0.39). Histopathological features of HCCs without APHE included cirrhotic stromal reaction, marked tumour cell steatosis and absence of the typical surrounding dilated sinusoidal vascular channels. CONCLUSION Correlation with histopathological findings support the fact that HCCs with a lack of APHE in CEUS are a heterogeneous group. The examiner has to be aware that particularly HCCs with portal vein thrombosis or macro-invasion of the liver vessels may lack APHE.
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Affiliation(s)
- Deike Strobel
- Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen University Hospital, Erlangen, Germany
| | - Abbas Agaimy
- Institute of Pathoogy, Erlangen University Hospital, Erlangen, Germany
| | - Daniel Jesper
- Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen University Hospital, Erlangen, Germany
| | - Sebastian Zundler
- Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen University Hospital, Erlangen, Germany
| | - Barbara Schellhaas
- Department of Medicine 1 Gastroenterology Endocrinology and Pneumology, Erlangen University Hospital, Erlangen, Germany
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Fichtl A, Seufferlein T, Zizer E. Risks and benefits of TIPS in HCC and other liver malignancies: a literature review. BMC Gastroenterol 2023; 23:403. [PMID: 37986043 PMCID: PMC10662760 DOI: 10.1186/s12876-023-03047-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Transjugular intrahepatic portosystemic shunt (TIPS) is a well-validated treatment option for clinically significant portal hypertension (CSPH) in the context of liver cirrhosis. Its high efficacy and safety in the management of treatment-refractory ascites and variceal bleeding have been extensively proven. Contraindications for TIPS include severe right heart failure, hepatic encephalopathy, and sepsis. However, the role of liver malignancy in TIPS is debatable. Mostly, primary liver malignancies such as hepatocellular carcinoma (HCC) emerge from advanced liver diseases. Coexisting portal hypertension in HCC often results in limited treatment options and a poor prognosis. Previous studies have shown that TIPS implantation in patients with HCC is technically feasible and is usually not associated with major adverse events. Furthermore, TIPS may help in bridging the time to liver transplantation in early HCC and allow for locoregional treatment in advanced HCC. However, several studies suggest that seeding tumour cells to the lungs by TIPS placement might worsen the prognosis. CONCLUSIONS TIPS placement in patients with coexisting liver malignancy remains a case-by-case decision, and there is no profound evidence allowing general recommendations. This review aims to provide a state-of-the-art overview of the potential risks and benefits of TIPS placement in patients with liver malignancies.
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Affiliation(s)
- Anna Fichtl
- Department of Gastroenterology and Hepatology Internal Medicine I, University Ulm, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany.
| | - Thomas Seufferlein
- Department of Gastroenterology and Hepatology Internal Medicine I, University Ulm, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany
| | - Eugen Zizer
- Department of Gastroenterology and Hepatology Internal Medicine I, University Ulm, University Hospital Ulm, Albert-Einstein-Allee 23, Ulm, 89081, Germany
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Wiest I, Safai Zadeh E, Görg C, Teufel A, Michels G, Dietrich CF. Value of contrast-enhanced ultrasound for vascular diseases of the liver - current indications and open questions. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2023; 61:1504-1517. [PMID: 36522165 DOI: 10.1055/a-1973-5731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Contrast-enhanced ultrasonography (CEUS) is a widely available and well-tolerated technique that can expand the diagnosis of a variety of vascular liver diseases. This paper presents an overview of the current possibilities of the use of CEUS in vascular liver diseases. Particularly where Doppler sonography has technical limitations, CEUS provides additional opportunities to visualize vascular thrombosis and other obstructions restricting blood flow. When CT or MRI contrast agents cannot be used because of severe allergy or renal insufficiency, CEUS can be a valuable diagnostic alternative and has demonstrated comparable diagnostic performance in at least some vascular liver diseases, such as portal vein thrombosis. In addition, CEUS works without radiation and, therefore, might be particularly suitable for young patients and children. This may be useful, for example, in congenital disorders such as persistent umbilical vein or preduodenal portal vein. Vascular liver disease is rare and comprehensive data are still lacking, but the available literature provides promising insights into potential new ways to study vascular liver disease. Although most studies are based on small sample sizes or even case reports, the high diagnostic utility is undisputed.
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Affiliation(s)
- Isabella Wiest
- Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ehsan Safai Zadeh
- University Hospital Giessen and Marburg, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, Philipps University Marburg, Marburg, Germany
| | - Christian Görg
- University Hospital Giessen and Marburg, Gastroenterology, Endocrinology, Metabolism and Clinical Infectiology, Interdisciplinary Center of Ultrasound Diagnostics, Philipps University Marburg, Marburg, Germany
| | - Andreas Teufel
- Department of Medicine II, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland, Eschweiler, Germany
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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Laurent C, Rayar M, Maulat C, Muscari F, Marichez A, Gregoire E, Chopinet S, Mabrut JY, Boudjema K, Lesurtel M, Adam JP, Mohkam K, Chiche L. Liver transplantation and hepatocellular carcinoma: is TIPS deleterious? A multicentric retrospective study of the ARCHET research group with propensity score matching. Langenbecks Arch Surg 2023; 408:149. [PMID: 37052722 DOI: 10.1007/s00423-023-02875-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE A transjugular intrahepatic portosystemic shunt (TIPS) before the liver transplantation (LT) has been considered a contraindication in cases of hepatocellular carcinoma (HCC) because of the risk of tumour growth. We aimed to assess the impact of TIPS on incidental HCC and oncological outcomes in transplanted patients with pre-existing HCC. METHODS All consecutive transplanted patients for cirrhosis who had a previous TIPS with or without HCC were included. Between 2007 and 2014, 1912 patients were transplanted. We included 122 (6.3%) patients having TIPS before LT. A 1:3 matched cohort of 366 patients (18.9%) having LT without previous TIPS was selected using a propensity score. Incidental HCC rate and risk factor of HCC recurrence were evaluated using multivariate analysis with a competing risk model. RESULTS Before LT, in the TIPS group, 27 (22.1%) had an HCC vs. 81 (22.1%) in the control group (p = 1). The incidental HCC rate was similar: 10.5% (10/95) in the TIPS group vs. 6.3% (18/285) in the control group (p = 0.17). Recurrence occurred in 1/27 (3.7%) patient in the TIPS group and in 7/81 (8.6%) patients in the control group, without significant difference (p = 0.51). After multivariate regression, patient's gender (p < 0.01) was significantly associated with HCC recurrence while a tumour within Milan criteria (p = 0.01, sHR: 0.17 [0.04; 0.7]) and an incidental HCC (p<0.01) were found to be protector factors against HCC recurrence. CONCLUSION TIPS did not worsen the prognosis of transplanted patients for HCC. TIPS should no longer be contraindicated for oncological reasons in patients with HCC waiting for an LT.
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Affiliation(s)
- Christophe Laurent
- Department of Digestive Surgery and Liver Transplantation, Bordeaux University Hospital, Pessac, France.
| | - Michel Rayar
- Department of Visceral Surgery, University Hospital of Rennes, Rennes, France
| | - Charlotte Maulat
- Department of Visceral Surgery, Toulouse-Rangueil University Hospital, Toulouse, France
| | - Fabrice Muscari
- Department of Visceral Surgery, Toulouse-Rangueil University Hospital, Toulouse, France
| | - Arthur Marichez
- Department of Digestive Surgery and Liver Transplantation, Bordeaux University Hospital, Pessac, France
| | - Emilie Gregoire
- Department of General Surgery and Liver Transplantation, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Sophie Chopinet
- Department of General Surgery and Liver Transplantation, Hôpital de la Timone, Aix-Marseille University, Marseille, France
| | - Jean Yves Mabrut
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Karim Boudjema
- Department of Visceral Surgery, University Hospital of Rennes, Rennes, France
| | - Mickael Lesurtel
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Jean-Philippe Adam
- Department of Digestive Surgery and Liver Transplantation, Bordeaux University Hospital, Pessac, France
| | - Kayvan Mohkam
- Department of General Surgery & Liver Transplantation, Hospices Civils de Lyon, Croix-Rousse University Hospital, Claude-Bernard Lyon 1 University, Lyon, France
| | - Laurence Chiche
- Department of Digestive Surgery and Liver Transplantation, Bordeaux University Hospital, Pessac, France
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Tang L, Zhang Y, Zhou Q, Hong Q, Wang Z. The Relationship between Ultrasonographic Features of Hepatocellular Carcinoma and the Severity of Hepatocellular Carcinoma and the Expression of PTEN and Tg737. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:2608633. [PMID: 35368955 PMCID: PMC8970861 DOI: 10.1155/2022/2608633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/10/2022] [Accepted: 02/18/2022] [Indexed: 11/18/2022]
Abstract
To investigate the relationship between the ultrasonographic features of hepatocellular carcinoma (HCC) and the severity of HCC and the expression of tumor suppressor genes PTEN and Tg737, 90 patients with primary liver cancer are selected as the study subjects. The enhancement of liver tumor in arterial phase, portal venous phase, and delayed phase is observed by contrast-enhanced ultrasound (CEUS) before operation, and the echo intensity is compared with that of surrounding liver parenchyma. Immunohistochemistry is used to detect the expression of PTEN and Tg737 in hepatocellular carcinoma and paracancerous tissues. (1) In HCC, CEUS enhancement is characterized by rapid enhancement in arterial phase, enhancement in portal venous phase and delayed phase, and decreased hypoechoic changes. About 78.0% of the stage I-II liver cancer and 85.0% of the stage III-IV liver cancer show rapid enhancement and high echo in the arterial phase; only 8.0% of the stage I-II liver cancer shows moderate echo changes in the portal venous phase, while 32.5% (13/40) stage III-IV liver cancer shows moderate echo changes in the portal venous phase. (2) The positive rates of PTEN in liver cancer tissues and paracancerous tissues are 21.1% (19/90) and 70.0% (63/90), respectively, and the difference is statistically significant. The positive rates of Tg737 in liver cancer tissues and paracancerous tissues are 17.8% (16/90) and 75.6% (68/90), respectively, and the difference is statistically significant. Compared with PTEN and Tg737 negative groups, the ascending slope (RS) and initial elimination time (WT) of PTEN and Tg737 positive groups are significantly higher, indicating that the inflow velocity of contrast medium in the positive group is higher, the outflow time is shorter, and the lesions shows low enhancement rapidly. However, the expression of PTEN and Tg737 had no significant difference in maximal intensity (IMAX), peak time (TTP), and mean transit time (mTT). (3) Correlation analysis shows that the immunohistochemical scores of PTEN and Tg737 are not significantly correlated with IMAX, mTT, and TTP but positively correlated with RS (r = 0.359,P < 0.05), suggesting that the positive expressions of PTEN and Tg737 are negatively correlated with the inflow velocity of contrast medium. The immunohistochemical scores of PTEN and Tg737 are negatively correlated with WT, which indicated that the higher the expression intensity of PTEN is, the longer the outflow time of contrast medium is and the slower the outflow of contrast medium is. There is a significant correlation between the expression of PTEN and Tg737 proteins and CEUS parameters in hepatocellular carcinoma.
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Affiliation(s)
- Lei Tang
- Department of Oncology, Anhui No. 2 Provincial People's Hospital, Hefei 230041, China
| | - Yan Zhang
- Department of Oncology, Anhui No. 2 Provincial People's Hospital, Hefei 230041, China
| | - Qiong Zhou
- Department of Oncology, Anhui No. 2 Provincial People's Hospital, Hefei 230041, China
| | - Qiaojun Hong
- Department of Oncology, Anhui No. 2 Provincial People's Hospital, Hefei 230041, China
| | - Zhanggui Wang
- Department of Radiotherapy, Anhui No. 2 Provincial People's Hospital, Hefei 230041, China
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Wu L, Ning B, Yang J, Chen Y, Zhang C, Yan Y. Diagnosis of Liver Cirrhosis and Liver Fibrosis by Artificial Intelligence Algorithm-Based Multislice Spiral Computed Tomography. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:1217003. [PMID: 35341007 PMCID: PMC8941514 DOI: 10.1155/2022/1217003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 12/12/2022]
Abstract
This research was aimed at investigating the artificial intelligence (AI) segmentation algorithm-based multislice spiral computed tomography (MSCT) in the diagnosis of liver cirrhosis and liver fibrosis. Besides, it was aimed at providing new methods for the diagnosis of liver cirrhosis and liver fibrosis. All patients were divided into the control group, mild liver fibrosis group, and significant liver fibrosis group. A total of 112 patients were included, with 40 cases in the mild liver fibrosis group, 48 cases in the significant liver fibrosis group, and 24 cases who underwent computed tomography (CT) examination in the control group. In the research, deconvolution algorithm of AI segmentation algorithm was adopted to process the images. The average hepatic arterial fraction (HAF) values of patients in the control group, mild liver fibrosis group, and severe liver fibrosis group were 17.59 ± 10.03%, 18.23 ± 5.57%, and 20.98 ± 6.63%, respectively. The average MTT values of patients in the control group, mild liver fibrosis group, and severe liver fibrosis group were 12.69 ± 1.78S, 12.53 ± 2.05S, and 12.04 ± 1.57S, respectively. The average blood flow (BF) values of patients in the control group, mild liver fibrosis group, and severe liver fibrosis group were 105.68 ± 15.57 mL 100 g-1·min-1, 116.07 ± 16.5 mL·100 g-1·min-1, and 110.39 ± 16.32 mL·100 g-1·min-1, respectively. Besides, the average blood volume (BV) values of patients in the control group, mild liver fibrosis group, and significant liver fibrosis group were 15.69 ± 4.35 mL·log-1, 16.97 ± 2.68 mL·log-1, and 16.11 ± 4.87 mL·100 g-1, respectively. According to statistics, the differences among the average HAF, MTT, BF, and BV values showed no statistical meaning. AI segmentation algorithm-based MSCT imaging could promote the diagnosis of liver cirrhosis and liver fibrosis effectively and offer new methods to clinical diagnosis of liver cirrhosis and liver fibrosis.
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Affiliation(s)
- Liexiu Wu
- Department of Infectious Disease, Baoji Central Hospital, Baoji, 721008 Shaanxi, China
| | - Bo Ning
- Department of Infectious Disease, Baoji Central Hospital, Baoji, 721008 Shaanxi, China
| | - Jianjun Yang
- Department of Infectious Disease, Baoji Central Hospital, Baoji, 721008 Shaanxi, China
| | - Yanni Chen
- Department of Immunization Plan, Disease Control and Prevention of Yulin Center, Yulin, 719000 Shaanxi, China
| | - Caihong Zhang
- Department of Health, Disease Control and Prevention of Yulin Center, Yulin, 719000 Shaanxi, China
| | - Yun Yan
- Department of Chronic Disease Control, Yulin City Center for Disease Control and Prevention, Yulin, 719000 Shaanxi, China
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Marschner CA, Geyer T, Froelich MF, Rübenthaler J, Schwarze V, Clevert DA. Diagnostic Value of Contrast-Enhanced Ultrasound for Evaluation of Transjugular Intrahepatic Portosystemic Shunt Perfusion. Diagnostics (Basel) 2021; 11:1593. [PMID: 34573935 PMCID: PMC8472159 DOI: 10.3390/diagnostics11091593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/11/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In patients with liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) displays an effective method for treating portal hypertension. Main indications include refractory ascites and secondary prevention of esophageal bleeding. Color Doppler ultrasound (CDUS) plays a leading role in the follow-up management, whereas contrast-enhanced ultrasound (CEUS) is not routinely considered. We compared the efficacy of CEUS to CDUS and highlighted differences compared to findings of corresponding computed tomography (CT) and magnetic resonance imaging (MRI). (2) Methods: On a retrospective basis, 106 patients with CEUS examination after TIPS were included. The enrollment period was 12 years (between 2008 and 2020) and the age group ranged from 23.3 to 82.1 years. In addition, 92 CDUS, 43 CT and 58 MRI scans were evaluated for intermodal comparison. (3) Results: Intermodal analysis and comparison revealed a high level of concordance between CDUS, CT and MRI in the vast majority of cases. In comparison to CDUS, the correlation of the relevant findings was 92.5%, 95.3% for CT and 87.9% for MRI. In some cases, however, additional information was provided by CEUS (4) Conclusions: CEUS depicts a safe and effective imaging modality for follow-up after TIPS. In addition to CDUS, CEUS enables specific assessment of stent pathologies and stent dysfunction due to its capacity to dynamically visualize single microbubbles at high spatial and temporal resolution. Due to the low number of adverse events regarding the application of contrast agents, CEUS can be administered to a very broad patient population, thus avoiding additional radiation exposure compared to CT angiography in cases with divergent findings during follow-up.
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Affiliation(s)
- Constantin A. Marschner
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (T.G.); (J.R.); (V.S.); (D.-A.C.)
| | - Thomas Geyer
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (T.G.); (J.R.); (V.S.); (D.-A.C.)
| | - Matthias F. Froelich
- Department of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, 68167 Mannheim, Germany;
| | - Johannes Rübenthaler
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (T.G.); (J.R.); (V.S.); (D.-A.C.)
| | - Vincent Schwarze
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (T.G.); (J.R.); (V.S.); (D.-A.C.)
| | - Dirk-André Clevert
- Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany; (T.G.); (J.R.); (V.S.); (D.-A.C.)
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