Article Dans Une Revue World journal of hepatology Année : 2017

Evaluation of Doppler-ultrasonography in the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction: A prospective study

Hervé Trillaud
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Adeline Abjean
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Olivier Ami
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Ophélie Aumont
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Aurélien Dupré
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Martin Franz
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Bertrand Le Roy
Gérard Mage
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Jean-Christophe Maran
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Résumé

Aim: To prospectively evaluate the performance of Doppler-ultrasonography (US) for the detection of transjugular intrahepatic portosystemic shunt (TIPS) dysfunction within a multicenter cohort of cirrhotic patients.
Methods: This study was conducted in 10 french teaching hospitals. After TIPS insertion, angiography and liver Doppler-US were carried out every six months to detect dysfunction (defined by a portosystemic gradient ≥ 12 mmHg and/or a stent stenosis ≥ 50%). The association between ultrasonographic signs and dysfunction was studied by logistic random-effects models, and the diagnostic performance of each Doppler criterion was estimated by the bootstrap method. This study was approved by the ethics committee of Tours.
Results: Two hundred and eighteen pairs of examinations performed on 87 cirrhotic patients were analyzed. Variables significantly associated with dysfunction were: The speed of flow in the portal vein (P = 0.008), the reversal of flow in the right (P = 0.038) and left (P = 0.049) portal branch, the loss of modulation of portal flow by the right atrium (P = 0.0005), ascites (P = 0.001) and the overall impression of the operator (P = 0.0001). The diagnostic performances of these variables were low; sensitivity was < 58% and negative predictive value was < 73%. Therefore, dysfunction cannot be ruled out from Doppler-US.
Conclusion: The performance of Doppler-US for the detection of TIPS dysfunction is poor compared to angiography. New tools are needed to improve diagnosis of TIPS dysfunction.

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hal-02094449 , version 1 (25-02-2025)

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Charlotte Nicolas, Amélie Le Gouge, Louis D’alteroche, Jean Ayoub, Monica Georgescu, et al.. Evaluation of Doppler-ultrasonography in the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction: A prospective study. World journal of hepatology, 2017, 9 (27), pp.1125-1132. ⟨10.4254/wjh.v9.i27.1125⟩. ⟨hal-02094449⟩
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