MR-guided transjugular intrahepatic portosystemic shunt creation with use of a hybrid radiography/MR system.
OBJECTIVE
To evaluate the performance of a combined hybrid radiography/magnetic resonance (MR) unit to guide portal vein (PV) puncture during human transjugular intrahepatic portosystemic shunt (TIPS) creation.


METHODS
Fourteen patients undergoing TIPS creation were studied during standard clinical applications. Patients were anesthetized and then positioned in an open MR unit containing a flat-panel radiographic fluoroscopic unit. With use of a combination of fluoroscopy and MR imaging, the PV was accessed and the TIPS procedure was performed. A noncovered nitinol stent or a covered stent-graft was placed in the TIPS tract. Number of punctures required, total procedure time, fluoroscopy time, procedural success rate, complications, and ultrasonographic and clinical follow-up were recorded.


RESULTS
Clinical success was obtained in 13 of 14 patients. In one patient, extrahepatic puncture of the PV occurred, resulting in hemorrhage and requiring placement of a covered stent to control the bleeding. The mean number of punctures required to access the PV was 2.6 +/- 1.7, and the total procedure time was 2.5 hours +/- 0.6. Mean fluoroscopy time was 22.3 minutes +/- 5.5. Results of clinical and ultrasonographic follow-up compare favorably to previously published reports.


CONCLUSIONS
TIPS creation with a combination hybrid radiography/MR unit is feasible and may reduce the number of needle passes required and radiation exposure, with similar overall outcomes compared with studies reported in the literature.
Kee
Stephen T
ST
Department of Radiology, Stanford University, California 94305, USA. skee@stanford.edu
Ganguly
Arundhuti
A
Daniel
Bruce L
BL
Wen
Zhifei
Z
Butts
Kim
K
Shimikawa
Anne
A
Pelc
Norbert J
NJ
Fahrig
Rebecca
R
Dake
Michael D
MD
D000497:Alloys; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D011677:Punctures / Q000009:adverse effects / Q000295:instrumentation; D015641:Radiography, Interventional / Q000379:methods; D015642:Radiology, Interventional / Q000379:methods; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
D000497:Alloys; C013616:nitinol