Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, 982000 Nebraska Medical Center, Omaha, NE, 68198-2000, USA.
Division of Gastroenterology, Louisiana State University Health Science Center, Shreveport, LA, USA.
Abdom Radiol (NY). 2019 Jul;44(7):2392-2402. doi: 10.1007/s00261-019-01981-w.
Although ultrasound has been widely used to evaluate transjugular intrahepatic portosystemic shunts (TIPS) patency, several studies have reported conflicting data regarding its performance. Therefore, we aimed to evaluate performance of ultrasound for detection of TIPS dysfunction by performing a meta-analysis.
Literature search was performed for studies evaluating ultrasound for TIPS dysfunction, stenosis, and occlusion using PubMed, EMBASE, Scopus, and Cochrane Library through February 2019. Pooled sensitivity, specificity, log diagnostic odds ratio (LDOR), and area under curve (AUC) of summary receiver-operating characteristic were calculated. Subgroup analyses were performed according to ultrasonographic criteria and type of stent.
In total, 21 studies were evaluated. Pooled sensitivity, specificity, and LDOR of ultrasound for detection of TIPS dysfunction were 0.82 (0.67, 0.93), 0.58 (0.46, 0.70), and 1.77 (1.20, 2.35). Pooled sensitivity, specificity, and LDOR for TIPS stenosis were 0.80 (0.69, 0.90), 0.80 (0.69, 0.91), and 2.83 (1.88, 3.78). Pooled sensitivity, specificity, and LDOR for TIPS occlusion were 0.96 (0.92, 0.99), 1 (0.99, 1.00), and 6.28 (4.96, 7.60). AUCs of ultrasound for TIPS dysfunction, stenosis, and occlusion were 0.77, 0.86, and 0.95, respectively.
Although ultrasound had excellent performance for TIPS occlusion and acceptable performance for TIP stenosis, most studies utilized bare metal stent, and therefore, application to current practice is limited. Ultrasound for TIPS dysfunction in the setting of covered metal stent appeared to have acceptable sensitivity of 0.82, but limited specificity of 0.58 and low LDOR of 1.77. A new noninvasive tool is needed for detection of TIPS dysfunction in the era of covered metal stent.
尽管超声已广泛用于评估经颈静脉肝内门体分流术（TIPS）通畅性，但几项研究报告的结果存在差异。因此，我们旨在通过荟萃分析评估超声检测 TIPS 功能障碍的性能。
通过检索 PubMed、EMBASE、Scopus 和 Cochrane Library 中的文献，检索评估超声检测 TIPS 功能障碍、狭窄和闭塞的研究，检索时间截至 2019 年 2 月。计算汇总受试者工作特征曲线的敏感性、特异性、对数诊断比值比（LDOR）和曲线下面积（AUC）。根据超声标准和支架类型进行亚组分析。
共评估了 21 项研究。超声检测 TIPS 功能障碍的汇总敏感性、特异性和 LDOR 分别为 0.82（0.67，0.93）、0.58（0.46，0.70）和 1.77（1.20，2.35）。TIPS 狭窄的汇总敏感性、特异性和 LDOR 分别为 0.80（0.69，0.90）、0.80（0.69，0.91）和 2.83（1.88，3.78）。TIPS 闭塞的汇总敏感性、特异性和 LDOR 分别为 0.96（0.92，0.99）、1（0.99，1.00）和 6.28（4.96，7.60）。超声检测 TIPS 功能障碍、狭窄和闭塞的 AUC 分别为 0.77、0.86 和 0.95。
尽管超声对 TIPS 闭塞具有良好的性能，对 TIPS 狭窄具有可接受的性能，但大多数研究均使用裸金属支架，因此，其在当前实践中的应用受到限制。在使用覆膜金属支架的情况下，超声检测 TIPS 功能障碍的敏感性为 0.82，特异性为 0.58，LDOR 较低（1.77），具有一定的应用价值。在覆膜金属支架时代，需要一种新的非侵入性工具来检测 TIPS 功能障碍。
