Institute of Ultrasound Imaging, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
J Ultrasound Med. 2013 Feb;32(2):221-8. doi: 10.7863/jum.2013.32.2.221.
To prospectively assess changes in spleen stiffness and splenoportal venous flow before and after transjugular intrahepatic portosystemic shunt (TIPS) placement.
We prospectively evaluated spleen stiffness measured by the mean shear wave velocity with acoustic radiation force impulse imaging and the splenoportal venous velocity with color Doppler sonography in 12 patients (mean age ± SD, 42.6 ± 11.0 years; range, 29-65 years) who underwent TIPS placement for portal hypertension and gastroesophageal bleeding. The mean shear wave velocity and angle-corrected splenoportal venous velocity at the main portal and splenic veins were measured 1 day before and 3 to 9 days after TIPS placement (mean interval, 6.0 ± 1.95 days; range, 4-10 days) and were compared with portal vein pressure measured during the procedure.
There was a significant difference in portal vein pressure before and after TIPS (25.34 ± 6.21 versus 15.66 ± 6.07 mm Hg; P = .0005). After TIPS, the mean shear wave velocity decreased significantly in all 12 cases (3.50 ± 0.46 versus 3.15 ± 0.39 m/s before and after TIPS; P = .00015). The flow velocity at the main portal vein increased significantly after TIPS (22.21 ± 4.13 versus 47.25 ± 12.37 cm/s; P = .0000051). The splenic vein velocity and spleen index measured 25.57 ± 6.98 cm/s and 55.99 ± 21.27 cm(2), respectively, before TIPS and 35.72 ± 11.10 cm/s and 50.11 ± 21.12 cm(2) after TIPS (P = .0004 and .003).
A significant decrease in the mean shear wave velocity and increase in the splenoportal venous velocity occurred with reduced portal vein pressure after TIPS placement. Hence, both parameters can be used as noninvasive quantitative markers for monitoring TIPS function after placement.
前瞻性评估经颈静脉肝内门体分流术（TIPS）前后脾脏硬度和脾门静脉血流的变化。
我们前瞻性评估了 12 例接受 TIPS 治疗的门静脉高压和胃食管出血患者（平均年龄 ± 标准差，42.6 ± 11.0 岁；范围，29-65 岁）的脾脏硬度，采用声辐射力脉冲成像测量平均剪切波速度，采用彩色多普勒超声测量脾门静脉速度。在 TIPS 放置前 1 天和放置后 3-9 天（平均间隔 6.0 ± 1.95 天；范围，4-10 天）测量主门静脉和脾静脉的平均剪切波速度和校正后的脾门静脉速度，并与术中测量的门静脉压力进行比较。
TIPS 前后门静脉压力有显著差异（25.34 ± 6.21 与 15.66 ± 6.07 mmHg；P =.0005）。TIPS 后，12 例患者的平均剪切波速度均显著下降（TIPS 前后分别为 3.50 ± 0.46 和 3.15 ± 0.39 m/s；P =.00015）。TIPS 后主门静脉血流速度显著增加（TIPS 前后分别为 22.21 ± 4.13 和 47.25 ± 12.37 cm/s；P =.0000051）。TIPS 前脾静脉速度和脾指数分别为 25.57 ± 6.98 cm/s 和 55.99 ± 21.27 cm(2)，TIPS 后分别为 35.72 ± 11.10 cm/s 和 50.11 ± 21.12 cm(2)（P =.0004 和.003）。
TIPS 后门静脉压力降低，平均剪切波速度显著下降，脾门静脉血流速度增加。因此，这两个参数都可以作为 TIPS 放置后监测 TIPS 功能的非侵入性定量标志物。
