MR evaluation of portal hypertensive collateral shunting vessels for predicting outcome after transjugular intrahepatic portosystemic shunt

Abstract

Purpose: We assessed whether magnetic resonance (MR) imaging evaluation of porto-systemic collateral shunts can aid prediction of therapeutic effectiveness and complications after creation of a transjugular portosystemic shunt (TIPS), and technical diculty during the TIPS procedure. Materials and Methods: We retrospectively reviewed 32 patients (27 men, 5 women; mean age, 56.4 years) who underwent TIPS creation following gadolinium-enhanced MR examination. We measured the diameters of pre-existing portosystemic collateral shunting vessels, added the measurements together to generate a shunting collateral score for each patient, and divided patients into 2 groups by score of 4 or greater or less than 4. We then compared therapeutic effectiveness, technical difficulty and complications of the TIPS procedure, and portal venous (PV) pressure, PV-inferior vena cava (IVC) pressure gradient, and PV diameter between the groups. Results: The patients with a pre-existing large portosystemic shunt showed insignificant trends toward higher technical difficulty of the shunt procedure and rate of shunt dysfunction. The 2 groups showed no significant diŠerence in early mortality rate, onset or worsening rate of hepatic encephalopathy after TIPS creation, PV pressure, PV-IVC pressure gradient, or PV diameter. Conclusion: Gadolinium-enhanced MR imaging may help in predicting technical difficulty and complications of TIPS.