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Yang C, Chen Y, Wang C, Liu J, Huang S, Zhou C, Wang Y, Ju S, Li T, Bai Y, Yao W, Xiong B. Portal flow diversion based on portography is superior than puncture site in the prediction of overt hepatic encephalopathy after TIPS creation. BMC Gastroenterol 2022; 22:363. [PMID: 35906529 PMCID: PMC9336111 DOI: 10.1186/s12876-022-02447-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Targeted puncture of an appropriate portal venous branch during transjugular intrahepatic portosystemic shunt (TIPS) procedure may reduce the risk of postprocedural overt hepatic encephalopathy (HE). This study aimed to describe blood distribution under portography and combined it with puncture site to determine portal flow diversion, and to evaluate its prognostic value in predicting post-TIPS overt HE. Methods In this retrospective analysis of patients with cirrhosis undergoing TIPS, we included 252 patients to describe blood distribution under portography and 243 patients to assess the association between portal flow diversion and post-TIPS overt HE. Results At the first stage, 51 (20.2%) patients were identified as type A (unilateral type with the right portal branch receives blood from splenic vein [SV]), 16 (6.4%) as type B (unilateral type with the right branch receives blood from superior mesenteric vein [SMV]) and 185 (73.4%) as type C (fully mixed type). At the second stage, 40 patients were divided into the SV group, 25 into the SMV group and 178 into the mixed group. Compared with the mixed group, the risk of post-TIPS overt HE was significantly higher in the SMV group (adjusted HR 3.70 [95% CI 2.01–6.80]; p < 0.001), whereas the SV group showed a non-significantly decreased risk (adjusted HR 0.57 [95% CI 0.22–1.48]; p = 0.25). Additionally, the SMV group showed a substantial increase in ammonia level at 3 days and 1 month after procedure. Conclusions Our results support the clinical use of portal flow diversion for risk stratification and decision-making in the management of post-TIPS overt HE. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02447-y.
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Affiliation(s)
- Chongtu Yang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yang Chen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chaoyang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Jiacheng Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Songjiang Huang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chen Zhou
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yingliang Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Shuguang Ju
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Tongqiang Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yaowei Bai
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Wei Yao
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Bin Xiong
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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Maruyama H, Okugawa H, Ishibashi H, Takahashi M, Kobayashi S, Yoshizumi H, Yokosuka O. Carbon dioxide-based portography: an alternative to conventional imaging with the use of iodinated contrast medium. J Gastroenterol Hepatol 2010; 25:1111-6. [PMID: 20594227 DOI: 10.1111/j.1440-1746.2010.06248.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIM To clarify the efficacy of carbon dioxide (CO(2)) as a contrast material to evaluate portal vein images by percutaneous transhepatic portography (PTP). METHODS Twenty patients (38-76 years; male 13, female 7) with chronic liver diseases were the subjects of this prospective study. Portal venous opacification by PTP was compared between CO(2)-based images and iodinated contrast medium (ICM)-based images by two independent reviewers, according to the three-grade scoring; 0 for none, 1 for weak and 2 for sufficient. RESULTS Total scores of extrahepatic portal veins (137 for CO(2), 93 for ICM), collateral vessels (64 for CO(2), 60 for ICM) and intrahepatic portal veins (69 for CO(2), 76 for ICM) were not statistically significant between CO(2)-based and ICM-based images (P = 0.0623). Sufficient opacification of superior mesenteric vein was more frequent on CO(2)-based images (none 0, weak 4, sufficient 16) than ICM-based images (none 19, weak 0, sufficient 1; P < 0.0001). The score was not statistically significant between CO(2)-based and ICM-based images in portal trunk, splenic vein, inferior mesenteric vein and other collateral vessels. Although opacification grade in the intrahepatic left portal vein was not statistically significant between CO(2)-based and ICM-based images (P = 0.1515), weak opacification was significantly frequent on CO(2)-based images (weak 10, sufficient 10) compared to ICM-based images (weak 0, sufficient 20; P = 0.0003) in the intrahepatic right portal vein. Inter-reviewer agreement was excellent between the two reviewers for CO(2)-based images (kappa = 0.913) and ICM-based images (kappa = 0.924). CONCLUSIONS Carbon dioxide may be a first-line contrast material for evaluating portal vein images by PTP.
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Affiliation(s)
- Hitoshi Maruyama
- Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Chiba, Japan.
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Puppala S, Patel J, Woodley H, Alizai NK, Kessel D. Preoperative imaging of left portal vein at the Rex recess for Rex shunt formation using wedged hepatic vein carbon dioxide portography. J Pediatr Surg 2009; 44:2043-7. [PMID: 19853771 DOI: 10.1016/j.jpedsurg.2009.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2009] [Revised: 05/31/2009] [Accepted: 06/01/2009] [Indexed: 11/16/2022]
Abstract
BACKGROUND In children with extrahepatic portal vein obstruction (EHPVO), formation of a mesentericoportal bypass (Rex shunt) restores hepatopetal flow, relieves portal hypertension, and reduces variceal bleeding and hypersplenism. The Rex shunt is created by inserting a vein graft between the superior mesenteric vein and the umbilical segment (Rex) of the left portal vein within the Rex recess of the liver. The preoperative evaluation of a patient with EHPVO includes an accurate assessment of the venous inflow and outflow. The inflow portal vein is readily assessed by ultrasound and magnetic resonance imaging. The outflow intrahepatic portal vein is harder to assess. We report our experience of patients evaluated with wedged hepatic vein carbon dioxide portography (WHVCP). METHOD All children referred for venography from October 2001 to October 2007 were prospectively identified, and clinical and radiologic data were reviewed retrospectively. The imaging findings were correlated to findings at surgery. RESULTS Eleven children (range, 3-14 years, median, 6 years) were referred for preoperative wedged hepatic venography. The left portal vein at the Rex recess was clearly identified in 9 patients (82%). In the other 2 patients (18%), the Rex segment was not identified despite opacification of left and right intrahepatic portal veins; this was taken to indicate an occluded segment. Wedged venography was performed with carbon dioxide in 10 patients (91%). Carbon dioxide was contraindicated in the final patient because of the presence of a ventricular septal defect. CONCLUSION Our series demonstrates the use of WHVCP as a diagnostic tool in preoperative assessment of the Rex segment of left portal vein in children with extrahepatic portal vein obstruction.
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Affiliation(s)
- Sapna Puppala
- Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS13EX, United Kingdom.
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Teng GJ, Deng G, Liu ZS, Fang W, Zhu GY, Li GZ, Guo JH, He SC, Dong YH. Ultrafine needle CO2 splenoportography: a comparative investigation with transarterial portography and MR portography. Eur J Radiol 2006; 59:393-400. [PMID: 16603330 DOI: 10.1016/j.ejrad.2006.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2005] [Revised: 01/26/2006] [Accepted: 03/03/2006] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the safety and quality of CO2 splenoportography (CO2-SP) by comparison to 3-dimensional dynamic contrast-enhanced magnetic resonance portography (3D-DCE-MRP) and transarterial portography (TAP). MATERIALS AND METHODS CO2-SP, 3D-DCE-MRP and TAP were performed within 3 days in 35 patients. CO2-SP was conducted with a 26G needle by puncture of spleen under fluoroscopy and/or ultrasound guidance. A fifty mm3 of CO2 was manually injected within 3s. The safety and the side effects of CO2-SP were assessed with a scoring system based on both the subjective feeling of patients questioned and the objective appearances of vital signs, electrocardiogram (ECG) and saturation of percutaneous blood oxygen (SpO2). The quality of the imaging was compared among the three groups using different methods by a scoring criterion based on visualization of the portal branches. RESULTS Transient mild discomfortable reaction was present in 18 patients (51.4%). The scores measured for quality of portal vein branch visualization in the groups with CO2-SP, 3D-DCE-MRP and TAP were 226, 196 and 167, respectively (P<0.001, the higher of the scores, the better of the quality). The visibility of collateral veins was not significantly different amongst the three imaging techniques. CONCLUSION Ultrafine needle CO2-SP is safe and minimally invasive. The quality of CO2-SP is better than that with 3D-DCE-MRP and TAP in terms of the visualizing portal vein branches.
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Affiliation(s)
- Gao-Jun Teng
- Department of Radiology, Zhong-Da Hospital, Southeast University, 87# Dingjiaqiao Road, Nanjing 210009, China.
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