Department of Diagnostic and Interventional Radiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Mainz, Germany.
Abdom Radiol (NY). 2018 Oct;43(10):2868-2875. doi: 10.1007/s00261-018-1547-7.
To analyze the feasibility of 2D-perfusion angiography (2D-PA) to quantify flow and perfusion changes pre- and post-transjugular intrahepatic portosystemic shunt (TIPS) revision.
Fifteen consecutive patients (54 ± 14 years, seven men and eight women) scheduled for TIPS revision were included in this study. To quantify flow and perfusion changes caused by TIPS revision, digital subtraction angiography (DSA) series acquired during the revision were post-processed using a dedicated software. Reference region-of-interest (ROI) in the main portal vein (input function) and target ROIs in the TIPS lumen, the liver parenchyma and in the right atrium were placed in corresponding areas on DSA pre- and post-TIPS revision. 2D-PA evaluation included time to peak (TTP), peak density (PD), and the area under the curve (AUC) assessment. The ratios of reference ROI to target ROIs pre- and post-TIPS revision were calculated (TTP/TTP, PD/PD, AUC/AUC, TTP/TTP, PD/PD, AUC/AUC, TTP/TTP, PD/PD, and AUC/AUC). Pressure measurements pre- and post-TIPS revision were performed and correlated to the 2D-PA parameters. Reproducibility of 2D-PA was assessed by the intra-class correlation coefficient (ICC).
The portosystemic pressure gradient was significantly reduced following TIPS revision (17.1 ± 6.3 vs. 8.9 ± 4.3 mmHg; p < 0.0001). PD/PD (0.22 vs. 0.35; p = 0.0014) and AUC/AUC (0.24 vs. 0.39; p = 0.0012) increased significantly. Likewise, PD/PD (0.32 vs. 0.78; p = 0.0004) and AUC/AUC (0.3 vs. 0.79; p < 0.0001) increased, whereas PD/PD decreased significantly (0.14 vs. 0.1; p = 0.0084). Pressure gradient changes correlated significantly with the increase in PD/PD (r = - 0.77, p = 0.0012) and AUC/AUC (r = - 0.76, p = 0.0018). ICC of the 2D-PA parameters was in the range of 0.88-0.99.
2D-PA offers a feasible approach to quantify flow and perfusion changes during TIPS revision. Therefore, 2D-PA may be a valuable amendment to mere pressure measurements.
分析二维灌注血管造影术（2D-PA）在经颈静脉肝内门体分流术（TIPS）修订前后量化流量和灌注变化的可行性。
本研究纳入了 15 例连续接受 TIPS 修订的患者（54±14 岁，男性 7 例，女性 8 例）。为了量化 TIPS 修订引起的流量和灌注变化，使用专用软件对修订过程中获取的数字减影血管造影（DSA）系列进行后处理。在 TIPS 修订前后的 DSA 上，将参考门静脉（输入功能）中的 ROI 和 TIPS 管腔、肝实质和右心房中的目标 ROI 放置在相应的区域。2D-PA 评估包括达峰时间（TTP）、峰值密度（PD）和曲线下面积（AUC）评估。计算 TIPS 修订前后参考 ROI 与目标 ROI 的比值（TTP/TTP、PD/PD、AUC/AUC、TTP/TTP、PD/PD、AUC/AUC、TTP/TTP、PD/PD 和 AUC/AUC）。在 TIPS 修订前后进行压力测量，并与 2D-PA 参数相关联。通过组内相关系数（ICC）评估 2D-PA 的可重复性。
TIPS 修订后门体系统压力梯度明显降低（17.1±6.3 与 8.9±4.3mmHg；p<0.0001）。PD/PD（0.22 与 0.35；p=0.0014）和 AUC/AUC（0.24 与 0.39；p=0.0012）显著增加。同样，PD/PD（0.32 与 0.78；p=0.0004）和 AUC/AUC（0.3 与 0.79；p<0.0001）增加，而 PD/PD 显著降低（0.14 与 0.1；p=0.0084）。压力梯度变化与 PD/PD（r=-0.77，p=0.0012）和 AUC/AUC（r=-0.76，p=0.0018）的增加显著相关。2D-PA 参数的 ICC 在 0.88-0.99 之间。
2D-PA 为量化 TIPS 修订期间的流量和灌注变化提供了一种可行的方法。因此，2D-PA 可能是单纯压力测量的有益补充。
