Contrast-enhanced ultrasound: a new method for TIPS follow-up

To determine the diagnostic value of contrast-enhanced ultrasound (CEUS) for the detection of TIPS (transjugular intrahepatic portosystemic shunt) complications.

67 cirrhotic patients who underwent TIPS between 2001 and 2008 were retrospectively reviewed. Sixty-two vascular examinations in 37 patients for suspicion of TIPS dysfunction based on the clinical or radiological criteria were analyzed and compared with the 62 related Doppler and CEUS examinations obtained previously. Abnormal CEUS was defined as poor opacification of the prosthesis compared to the native portal vein, stent stenosis, hepatic vein stenosis, and occlusion of the stent.

Among the 62 vascular examinations, 56 were considered as pathologic, including: 20 occlusions, 25 stent stenoses, 9 hepatic vein stenoses, 1 arterial-TIPS fistula, and 1 strong flow stealing through a voluminous paraumbilical vein associated with a patent shunt. 50 were exactly correlated with a previous CEUS examination, including 20/20 occlusions (100%), 23/25 stent stenoses (91%), 5/9 hepatic vein stenoses (56%), 1/1 fistula (100%), and 1/1 strong flow stealing (100%). Two CEUS and 14 Doppler examinations were false negative.

CEUS allows direct visualization of intra-prosthetic flow, with a qualitative and anatomic study, in addition to the Doppler examination. This is a new, simple, and effective technique for TIPS follow-up.