Quantification of intrahepatic portosystemic shunting after placement of a transjugular intrahepatic portosystemic shunt.
OBJECTIVE
To quantify portosystemic shunting and hepatic portal perfusion after placement of a transjugular intrahepatic portosystemic shunt (TIPS).


METHODS
Technetium-99m macroaggregated albumin (MAA) was injected directly into the portal veins of nine asymptomatic patients 3 months after TIPS placement. Portosystemic shunting was quantified by comparing counts in the lungs with those in the liver. One cirrhotic patient and one healthy patient who received portal MAA injections were used as controls.


RESULTS
No portosystemic shunting was found in the healthy patient. In the cirrhotic control patient, 77% of the injected activity was in the lungs. Patients with portosystemic shunts had even more activity in the lungs. Even stenotic shunts diverted greater than 80% of portal blood flow systemically. Flow through the TIPS ranged from 84% to 100% (average, 93%); these fractions of flow correlated inversely with portosystemic pressure gradients.


CONCLUSIONS
Cirrhotic livers may divert much of the portal blood systemically before TIPS placement. Afterward, this proportion rises, and most portal flow is diverted into the pulmonary circulation.
Walser
E M
EM
Department of Radiology, University of Texas Medical Branch, Galveston 77555-0709, USA.
Harris
V M
VM
Harman
J T
JT
Park
H M
HM
Siddiqui
A R
AR
D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008102:Liver Circulation / Q000502:physiology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology; D011168:Portal System / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011652:Pulmonary Circulation / Q000502:physiology; D011877:Radionuclide Imaging; D013668:Technetium Tc 99m Aggregated Albumin
D013668:Technetium Tc 99m Aggregated Albumin