Grant E G, Tessler F N, Gomes A S, Holmes C L, Perrella R R, Duerinckx A J, Busuttil R W
Department of Radiological Sciences, University of California, Los Angeles, School of Medicine 90024.
AJR Am J Roentgenol. 1990 Feb;154(2):393-7. doi: 10.2214/ajr.154.2.2105035.
This study was designed to investigate the utility of color Doppler sonography in the evaluation of portosystemic shunts. Thirty-one patients with a total of 32 shunts were imaged. The types of shunts examined included portacaval, five; mesocaval, eight; distal splenorenal (Warren), 14; and mesoatrial, five. Sonography was performed without knowledge of the status of the shunt, although the type of shunt was known before beginning the study. The sonographic studies were evaluated to determine their sensitivity and specificity on the basis of a prospective comparison with angiography or MR imaging (22 cases). The possible advantages of color Doppler over duplex Doppler sonography in evaluating portosystemic shunts were also investigated, as was the ability of color Doppler sonography to image specifically the shunt anastomoses. Color Doppler sonography successfully inferred shunt patency (17 cases) or thrombosis (five cases) in all 22 shunts for which correlative imaging was available (sensitivity = 100%, specificity = 100%). In comparing duplex with color Doppler sonography in all 32 shunts, the two techniques were almost equally effective in establishing patency in portacaval, mesocaval, and mesoatrial shunts. Duplex Doppler sonography, however, provided useful diagnostic information in only four of 14 splenorenal shunts. Color Doppler correctly inferred patency or thrombosis in all 14. Among all 32 shunts, the anastomosis was shown clearly by color Doppler in 23, probably in four, and not all in five. Our results suggest that color Doppler sonography is an excellent method for the evaluation of all varieties of surgically created portosystemic shunts. In particular, color Doppler sonography appears to be superior to duplex Doppler sonography in imaging splenorenal communications.
本研究旨在探讨彩色多普勒超声在评估门体分流中的应用价值。对31例患者共32处分流进行了成像检查。检查的分流类型包括门腔分流5处、肠系膜上腔静脉分流8处、远端脾肾（沃伦）分流14处和肠系膜心房分流5处。超声检查在不了解分流状态的情况下进行，不过在研究开始前已知分流类型。根据与血管造影或磁共振成像（22例）的前瞻性比较，对超声检查结果进行评估以确定其敏感性和特异性。还研究了彩色多普勒在评估门体分流方面相对于双功多普勒超声的可能优势，以及彩色多普勒超声对分流吻合口进行特异性成像的能力。对于所有22处有相关成像的分流，彩色多普勒超声成功推断出分流通畅（17例）或血栓形成（5例）（敏感性 = 100%，特异性 = 100%）。在对所有32处分流的双功多普勒超声与彩色多普勒超声进行比较时，两种技术在确定门腔、肠系膜上腔静脉和肠系膜心房分流的通畅性方面几乎同样有效。然而，双功多普勒超声仅在14处脾肾分流中的4处提供了有用的诊断信息。彩色多普勒在所有14处均正确推断出通畅或血栓形成。在所有32处分流中，彩色多普勒清晰显示吻合口的有23处，可能显示的有4处，未全部显示的有5处。我们的结果表明，彩色多普勒超声是评估各种手术创建的门体分流的极佳方法。特别是，彩色多普勒超声在成像脾肾交通方面似乎优于双功多普勒超声。
