title: Portosystemic pressure reduction achieved with TIPPS and impact of portosystemic collaterals for the prediction of the portosystemic-pressure gradient in cirrhotic patients.
abstract: OBJECTIVE
  The portosystemic pressure gradient is an important factor defining prognosis in hepatic disease. However, noninvasive prediction of the gradient and the possible reduction by establishment of a TIPSS is challenging. A cohort of patients receiving TIPSS was evaluated with regard to imaging features of collaterals in cross-sectional imaging and the achievable reduction of the pressure gradient by establishment of a TIPSS.
  
  
  METHODS
  In this study 70 consecutive patients with cirrhotic liver disease were retrospectively evaluated. Patients received either CT or MR imaging before invasive pressure measurement during TIPSS procedure. Images were evaluated with regard to esophageal and fundus varices, splenorenal collaterals, short gastric vein and paraumbilical vein. Results were correlated with Child stage, portosystemic pressure gradient and post-TIPSS reduction of the pressure gradient.
  
  
  RESULTS
  In 55 of the 70 patients TIPSS reduced the pressure gradient to less than 12 mmHg. The pre-interventional pressure and the pressure reduction were not significantly different between Child stages. Imaging features of varices and portosystemic collaterals did not show significant differences. The only parameter with a significant predictive value for the reduction of the pressure gradient was the pre-TIPSS pressure gradient (r = 0.8, p<0.001).
  
  
  CONCLUSIONS
  TIPSS allows a reliable reduction of the pressure gradient even at high pre-interventional pressure levels and a high collateral presence. In patients receiving TIPSS the presence and the characteristics of the collateral vessels seem to be too variable to draw reliable conclusions concerning the portosystemic pressure gradient.
authors.affiliation: Department of Diagnostic Radiology, Department of Radiology, University of Tübingen, Germany. Electronic address: gerd.groezinger@med.uni-tuebingen.de.
authors.forename: Gerd
authors.initials: G
authors.lastname: Grözinger
authors.forename: Benjamin
authors.initials: B
authors.lastname: Wiesinger
authors.forename: Jörg
authors.initials: J
authors.lastname: Schmehl
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kramer
authors.forename: Tarun
authors.initials: T
authors.lastname: Mehra
authors.forename: Ulrich
authors.initials: U
authors.lastname: Grosse
authors.forename: Claudius
authors.initials: C
authors.lastname: König
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001795:Blood Pressure Determination / Q000379:methods*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: Collateral vessels; Portosytemic pressure gradient; TIPSS; Varices