Nicolas Charlotte, Le Gouge Amélie, d'Alteroche Louis, Ayoub Jean, Georgescu Monica, Vidal Vincent, Castaing Denis, Cercueil Jean-Pierre, Chevallier Patrick, Roumy Jérôme, Trillaud Hervé, Boyer Louis, Le Pennec Vincent, Perret Christophe, Giraudeau Bruno, Perarnau Jean-Marc
Service d'Hépato-Gastroentérologie, Hôpital Trousseau, CHRU Tours, 37044 Tours, France.
CIC, CHRU de Tours, 37044 Tours, France.
World J Hepatol. 2017 Sep 28;9(27):1125-1132. doi: 10.4254/wjh.v9.i27.1125.
To prospectively evaluate the performance of Doppler-ultrasonography (US) for the detection of transjugular intrahepatic portosystemic shunt (TIPS) dysfunction within a multicenter cohort of cirrhotic patients.
This study was conducted in 10 french teaching hospitals. After TIPS insertion, angiography and liver Doppler-US were carried out every six months to detect dysfunction (defined by a portosystemic gradient ≥ 12 mmHg and/or a stent stenosis ≥ 50%). The association between ultrasonographic signs and dysfunction was studied by logistic random-effects models, and the diagnostic performance of each Doppler criterion was estimated by the bootstrap method. This study was approved by the ethics committee of Tours.
Two hundred and eighteen pairs of examinations performed on 87 cirrhotic patients were analyzed. Variables significantly associated with dysfunction were: The speed of flow in the portal vein ( = 0.008), the reversal of flow in the right ( = 0.038) and left ( = 0.049) portal branch, the loss of modulation of portal flow by the right atrium ( = 0.0005), ascites ( = 0.001) and the overall impression of the operator ( = 0.0001). The diagnostic performances of these variables were low; sensitivity was < 58% and negative predictive value was < 73%. Therefore, dysfunction cannot be ruled out from Doppler-US.
The performance of Doppler-US for the detection of TIPS dysfunction is poor compared to angiography. New tools are needed to improve diagnosis of TIPS dysfunction.
前瞻性评估多普勒超声检查（US）在一组肝硬化患者多中心队列中检测经颈静脉肝内门体分流术（TIPS）功能障碍的性能。
本研究在10家法国教学医院进行。TIPS植入后，每6个月进行血管造影和肝脏多普勒超声检查以检测功能障碍（定义为门体压力梯度≥12 mmHg和/或支架狭窄≥50%）。通过逻辑随机效应模型研究超声征象与功能障碍之间的关联，并通过自助法估计每个多普勒标准的诊断性能。本研究经图尔伦理委员会批准。
分析了对87例肝硬化患者进行的218对检查。与功能障碍显著相关的变量有：门静脉血流速度（=0.008）、右门静脉分支（=0.038）和左门静脉分支（=0.049）血流逆转、右心房对门静脉血流调节的丧失（=0.0005）、腹水（=0.001）以及操作者的总体印象（=0.0001）。这些变量的诊断性能较低；敏感性<58%，阴性预测值<73%。因此，不能通过多普勒超声排除功能障碍。
与血管造影相比，多普勒超声检测TIPS功能障碍的性能较差。需要新的工具来改善TIPS功能障碍的诊断。
