title: Hepatic perfusion as a predictor of mortality after transjugular intrahepatic portosystemic shunt creation in patients with refractory ascites.
abstract: OBJECTIVE
  To determine whether hepatic perfusion patterns predict mortality after transjugular intrahepatic portosystemic shunt (TIPS) creation in patients with severe ascites.
  
  
  METHODS
  This retrospective study included 22 patients who had enhanced cine magnetic resonance (MR) imaging performed immediately before TIPS creation in the angled coronal plane including the left kidney, liver, and main portal vein. Regions of interest were centered over the liver and kidney, and perfusion curves were generated and reviewed before the standard TIPS procedure was performed. Four patients did not undergo TIPS creation as a result of very poor hepatic perfusion by MR. All patients were followed clinically and by ultrasound surveillance of their shunt.
  
  
  RESULTS
  Eleven patients died within 6 months, including all four patients who did not have a TIPS because of MR evidence of poor hepatic perfusion. Of these 11 patients, eight (73%) had unfavorable liver flow consisting of diminished enhancement compared to the kidney and early peak enhancement of less than 50 seconds. The surviving patients all showed a delayed peak enhancement of greater than 50 seconds.
  
  
  CONCLUSIONS
  In patients undergoing TIPS creation for refractory ascites, blunted arterial-type hepatic enhancement is a poor prognostic sign. Cine MR imaging with evaluation of hepatic perfusion can be performed and reviewed before the TIPS procedure. Alternative techniques for ascites reduction may be preferred for patients with unfavorable hepatic perfusion.
authors.affiliation: Department of Radiology, University of Texas Medical Branch, 301 University Boulevard, Galveston, Texas 77555-0709, USA. emwalser@utmb.edu
authors.forename: Eric
authors.initials: E
authors.lastname: Walser
authors.forename: Orhan S
authors.initials: OS
authors.lastname: Ozkan
authors.forename: Syed
authors.initials: S
authors.lastname: Raza
authors.forename: Roger
authors.initials: R
authors.lastname: Soloway
authors.forename: Leka
authors.initials: L
authors.lastname: Gajula
mesh_terms: D001201:Ascites / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology; D008099:Liver / Q000473:pathology; D008102:Liver Circulation; D017093:Liver Failure / Q000150:complications / Q000401:mortality; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate