title: MR evaluation of portal hypertensive collateral shunting vessels for predicting outcome after transjugular intrahepatic portosystemic shunt.
abstract: OBJECTIVE
  We assessed whether magnetic resonance (MR) imaging evaluation of portosystemic collateral shunts can aid prediction of therapeutic effectiveness and complications after creation of a transjugular portosystemic shunt (TIPS), and technical difficulty during the TIPS procedure.
  
  
  METHODS
  We retrospectively reviewed 32 patients (27 men, 5 women; mean age, 56.4 years) who underwent TIPS creation following gadolinium-enhanced MR examination. We measured the diameters of pre-existing portosystemic collateral shunting vessels, added the measurements together to generate a shunting collateral score for each patient, and divided patients into 2 groups by score of 4 or greater or less than 4. We then compared therapeutic effectiveness, technical difficulty and complications of the TIPS procedure, and portal venous (PV) pressure, PV-inferior vena cava (IVC) pressure gradient, and PV diameter between the groups.
  
  
  RESULTS
  The patients with a pre-existing large portosystemic shunt showed insignificant trends toward higher technical difficulty of the shunt procedure and rate of shunt dysfunction. The 2 groups showed no significant difference in early mortality rate, onset or worsening rate of hepatic encephalopathy after TIPS creation, PV pressure, PV-IVC pressure gradient, or PV diameter.
  
  
  CONCLUSIONS
  Gadolinium-enhanced MR imaging may help in predicting technical difficulty and complications of TIPS.
authors: Division of Magnetic Resonance Imaging, Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA. yoshikawa0816@aol.com
authors: Takeshi
authors: T
authors: Yoshikawa
authors: Donald G
authors: DG
authors: Mitchell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003097:Collateral Circulation; D003287:Contrast Media; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000601:surgery*; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications / Q000175:diagnosis; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome; D014682:Vena Cava, Inferior
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA