Journal
JOURNAL OF ULTRASOUND IN MEDICINE
Volume 34, Issue 2, Pages 257-266Publisher
AMER INST ULTRASOUND MEDICINE
DOI: 10.7863/ultra.34.2.257
Keywords
color flow; Doppler sonography; portal hypertension; power Doppler sonography; transjugular intrahepatic portosystemic shunt revision; vascular ultrasound; volume flow
Funding
- Michigan Institute for Clinical and Health Research (National Institutes of Health) [UL1RR024986]
- University of Michigan Health System
- GE Healthcare
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Objectives-Three-dimensional (3D)/4-dimensional (4D) sonographic measurement of blood volume flow in trans jugular intrahepatic portosystemic shunt revision with the intention of objective assessment of shunt patency. Methods-A total of 17 patients were recruited (12 male and 5 female; mean age, SS years; range, 30-69 years). An ultrasound system equipped with a 2.0-5.0-MHz probe was used to acquire multivolume 3D/4D color Doppler data sets to assess prerevision and postrevision shunt volume flow. Volume flow was computed offline based on the principle of surface integration of Doppler-measured velocity vectors in a lateral-elevational c-surface positioned at the color flow focal depth (range, 8.0-11.5 cm). Volume flow was compared to routine measurements of the prerevision and postrevision portosystemic pressure gradient. Prerevision volume flow was compared with the outcome to determine whether a flow threshold for revision could be defined. Results-Linear regression of data from revised transjugular intrahepatic portosystemic shunt cases showed an inverse correlation between the mean-normalized change in prerevision and postrevision shunt volume flow and the mean-normalized change in the prerevision and postrevision portosystemic pressure gradient (r(2) = 0.51; P =.020). Increased shunt blood flow corresponded to a decreased pressure gradient. Comparison of prerevision flows showed preliminary threshold development at 1534 mL/min, below which a shunt revision may be recommended (P=.21; area under the receiver operating characteristic curve = 0.78). Conclusions-Shunt volume flow measurement with 3D/4D Doppler sonography provides a potential alternative to standard pulsed wave Doppler metrics as an indicator of shunt function and predictor of revision.
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