title: MR angiographic guidance for transjugular intrahepatic portosystemic shunt procedures.
abstract: The authors used magnetic resonance (MR) angiography to guide catheter placement in transjugular intrahepatic portosystemic shunt (TIPS) procedures in nine of 18 patients and compared the results with those of the nine patients for whom prior planning based on MR angiography was not done. Two-dimensional time-of-flight MR venography was performed during breath hold, and projection venograms were formatted in sagittal, coronal, and axial planes. MR angiography defined venous anatomy sufficiently to shorten the procedure and help minimize invasiveness. With MR angiographic guidance, intrahepatic needle punctures were significantly fewer (without MR guidance: mean, 12.1; with MR guidance: mean, 3.6; P < .001) and associated complications were absent (without MR guidance: failed placement, n = 1; bleeding requiring blood transfusions, n = 1; death due to intraperitoneal hemorrhage with hemobilia, n = 1; and death due to hepatic capsular perforation, n = 1). The average time for the procedure was 2.9 hours without MR angiographic guidance and 1.8 hours with MR angiographic guidance (P < .001). The authors conclude that MR angiography is a useful technique for defining portal and hepatic venous anatomy before the TIPS procedure and that planning based on MR angiography may decrease the difficulty and length of the procedure.
authors.affiliation: Department of Radiology, Beth Israel Hospital, Boston, MA 02215.
authors.forename: M F
authors.initials: MF
authors.lastname: Müller
authors.forename: B
authors.initials: B
authors.lastname: Siewert
authors.forename: K R
authors.initials: KR
authors.lastname: Stokes
authors.forename: W D
authors.initials: WD
authors.lastname: Lewis
authors.forename: R L
authors.initials: RL
authors.lastname: Jenkins
authors.forename: M K
authors.initials: MK
authors.lastname: Stehling
authors.forename: J P
authors.initials: JP
authors.lastname: Finn
mesh_terms: D000328:Adult; D000368:Aged; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods; D005260:Female; D006431:Hemobilia / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006503:Hepatic Veins / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008099:Liver / Q000293:injuries; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010532:Peritoneal Diseases / Q000209:etiology; D011169:Portal Vein / Q000473:pathology; D011170:Portasystemic Shunt, Surgical; D011677:Punctures / Q000009:adverse effects; D015642:Radiology, Interventional; D013997:Time Factors