Kanterman R Y, Darcy M D, Middleton W D, Sterling K M, Teefey S A, Pilgram T K
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63112, USA.
AJR Am J Roentgenol. 1997 Feb;168(2):467-72. doi: 10.2214/ajr.168.2.9016228.
Our purpose was to determine the overall accuracy of Doppler sonography and the accuracy of specific Doppler parameters associated with a compromised transjugular intrahepatic portosystemic shunt (TIPS).
For 43 patients who had undergone TIPS, 64 correlated sonogram-venogram paired examinations were analyzed. Sonographic parameters assessed included absolute velocities plus absolute and percentage changes in velocities measured in the main portal vein (MPV) and in several intrashunt locations (including peak and minimum velocity). Direction of flow and change in direction of flow in the left and right portal veins were also examined. TIPS malfunction was defined as any shunt with greater than or equal to 50% stenosis or any stenosis with a portosystemic gradient greater than 15 mm Hg.
The prospective interpretation of the sonograms using all available parameters resulted in a sensitivity of 92% and a specificity of 72% for detecting TIPS malfunction. Peak shunt velocity (absolute velocity and velocity change), distal shunt velocity, MPV velocity (absolute velocity and percentage change in velocity), change in minimum shunt velocity, and direction of flow in branch portal veins were found to have statistically significant differences between normal and abnormal shunts. Sensitivities for these individual parameters ranged from 64% to 84%, and specificities ranged from 70% to 100%. When either the MPV velocity or the distal shunt velocity was abnormal, the sensitivity was 94%. When both parameters were abnormal, the specificity for detecting TIPS malfunction was 100%.
Doppler sonography is a sensitive and relatively specific means of revealing TIPS malfunction. Accuracy depends on analysis of multiple sonographic parameters.
我们的目的是确定多普勒超声检查的总体准确性以及与经颈静脉肝内门体分流术（TIPS）功能受损相关的特定多普勒参数的准确性。
对43例行TIPS的患者进行了64次相关的超声-静脉造影配对检查分析。评估的超声参数包括在主门静脉（MPV）和几个分流部位（包括峰值和最小速度）测量的绝对速度以及速度的绝对变化和百分比变化。还检查了左、右门静脉的血流方向和血流方向变化。TIPS功能障碍定义为任何狭窄程度大于或等于50%的分流或任何门体压差大于15 mmHg的狭窄。
使用所有可用参数对超声图进行前瞻性解读，检测TIPS功能障碍的敏感性为92%，特异性为72%。发现正常分流和异常分流之间，分流峰值速度（绝对速度和速度变化）、分流远端速度、MPV速度（绝对速度和速度百分比变化）、分流最小速度变化以及分支门静脉血流方向存在统计学显著差异。这些单个参数的敏感性范围为64%至84%，特异性范围为70%至100%。当MPV速度或分流远端速度异常时，敏感性为94%。当两个参数均异常时，检测TIPS功能障碍的特异性为100%。
多普勒超声检查是揭示TIPS功能障碍的一种敏感且相对特异的方法。准确性取决于对多个超声参数的分析。
