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Updated: Nov 25, 2025
Invasive Hemodynamic Characterization of the Portal-hypertensive Syndrome in Cirrhotic Rats
Published on: August 1, 2018
Spontaneous portosystemic shunts in cirrhosis: Detection, implications, and clinical associations
Sahaj Rathi1, Silvia Brocco2, Chiara Formentin2
1Department of Medicine-DIMED(,) University of Padova, Padova, Italy; Post Graduate Institute of Medical Education and Research, Chandigarh, India; Department of Earth, Atmospheric and Planetary Sciences, Massachusetts Institute of Technology, Cambridge, MA, United States.
Background:
Spontaneous portosystemic shunts (SPSS) are common in cirrhosis. Their characterization and clinical implications remain unclear.
Aims:
To devise a system of assessment of these shunts, and assess their clinical implications METHODS: We retrospectively studied patients with cirrhosis who underwent imaging in a liver transplant program. A novel index was computed to assess total SPSS -the diameter of a circle having an area equivalent to the sum of the areas of all the existing shunts. This 'SPSS equivalent diameter' was compared with the clinical variables.
Results:
Among 127 patients, 70% (CI95% 62-77) had SPSS, and 57% (CI95% 62-77) had multiple SPSS. The risk for SPSS was related to the severity of cirrhosis (Child-Pugh B/C vs. A: OR 2.4 CI95% 1.1-5.4) and alcoholic aetiology (OR 2.9 CI95% 1.2-7.1). The SPSS equivalent diameter was related to a history of HE, cognitive impairment (EEG/PHES) and ammonia(p<0.05). The diameter of the inferior cava vein >19.5 mm was a predictor of large SPSS (AUC 0.77, CI95%:0.68-0.87, p ≤ 0.001).
Conclusions:
The SPSS equivalent diameter, a comprehensive assessment of portosystemic shunting, was associated with severity of liver disease, hyperammonemia, and cognitive dysfunction. The diameter of the inferior vena cava was a good predictor of SPSS.
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