Departmentof Radiology, Adventist Health Bakersfield, Bakersfield, CA.
Comprehensive Care and Research Center, Cancer Centers of America, Newnan, GA.
AJR Am J Roentgenol. 2021 Jul;217(1):164-171. doi: 10.2214/AJR.20.23186. Epub 2021 May 12.
The purpose of the present study was to identify the subset of a wide range of serial Doppler, laboratory, and clinical parameters most predictive (both individually and in combination) of TIPS dysfunction in a large patient sample. The medical records of 189 patients who had undergone TIPS procedures were analyzed. The patients (mean age, 52 years; 62% of whom were men) had undergone 1139 Doppler studies and 323 portovenograms. Laboratory parameters included model for end-stage liver disease (MELD) scores, serum albumin levels, presence of ascites, and time since last intervention. Doppler parameters included intrashunt velocities, temporal change in intrashunt velocities, main portal vein velocity, direction of flow in the left portal hepatic vein, and venous pulsatility index. Statistical analysis used ROC, univariate, and multivariate regression models to assess the parameters both individually and in combination. Shunt dysfunction was defined by a portosystemic gradient of more than 12 mm Hg. The laboratory and clinical parameters of greatest predictive value included the MELD score and the time since the last intervention. The Doppler parameters that were of greatest predictive value included the change in velocity at the hepatic venous end and the left portal vein flow direction. Multivariate models produced an AUC of 0.74. Differences between functional and dysfunctional shunts were also statistically significant for absolute velocity at the hepatic venous end, the change in velocity within the stent, and the temporal change in the mid shunt velocity. The subset of serial parameters most predictive of TIPS dysfunction are the temporal change in the velocity at the hepatic venous end, the absolute velocity at the hepatic venous end, the direction of flow in the left portal venous branch, and changes in the MELD score.
本研究旨在确定广泛的一系列多普勒、实验室和临床参数中，哪些参数最能预测（单独和联合）大量患者样本中 TIPS 功能障碍。对 189 例接受 TIPS 手术的患者的病历进行了分析。这些患者（平均年龄 52 岁，其中 62%为男性）共进行了 1139 次多普勒检查和 323 次门腔静脉造影。实验室参数包括终末期肝病模型（MELD）评分、血清白蛋白水平、腹水存在情况以及上次干预后的时间。多普勒参数包括分流内速度、分流内速度的时间变化、主门静脉速度、左门静脉肝静脉内血流方向和静脉搏动指数。统计分析采用 ROC、单变量和多变量回归模型，分别评估参数和联合参数的价值。门腔静脉分流功能障碍定义为门腔静脉梯度>12mmHg。最具预测价值的实验室和临床参数包括 MELD 评分和上次干预后的时间。最具预测价值的多普勒参数包括肝静脉端速度变化和左门静脉血流方向。多变量模型产生的 AUC 为 0.74。功能和功能障碍分流之间的差异在肝静脉端的绝对速度、支架内速度变化和中分流速度的时间变化方面也具有统计学意义。最能预测 TIPS 功能障碍的一系列参数是肝静脉端速度的时间变化、肝静脉端的绝对速度、左门静脉分支的血流方向以及 MELD 评分的变化。
