超声造影在经颈静脉肝内门体支架分流术后支架管通畅性监测中的应用价值

Application value of contrast-enhanced ultrasonography in monitoring the stent patency after transjugular intrahepatic portosystemic shunt

目的评价超声造影(CEUS)在监测肝硬化患者经颈静脉肝内门体支架分流术(TIPS)后支架管通畅情况中的应用价值。方法回顾性分析2012年1—10月四川大学华西医院211例TIPS术后肝硬化患者的超声检查资料,其中40例行CEUS检查,14例行增强CT检查。以增强CT检查及临床随访结果作为金标准,分别计算彩色多普勒血流成像(CDFI)及CEUS诊断TIPS术后支架管闭塞的敏感度、特异度、阳性预测值及阴性预测值。结果二维超声显示所有支架管均位于门静脉与下腔静脉之间;CDFI显示171例患者支架管内血流充盈良好,38例支架管内未见血流信号,2例支架管血流充盈缺损。CEUS显示21例支架管通畅,17例支架管闭塞,2例支架管附壁血栓。17例CEUS诊断为支架管闭塞的患者中3例失访,14例行增强CT检查,均显示支架管闭塞。CDFI诊断TIPS术后支架管闭塞的敏感度、特异度、阳性预测者及阴性预测者分别为100%、89%、40%和100%;CEUS诊断TIPS术后支架管闭塞的敏感度、特异度、阳性预测者及阴性预测者均为100%。结论超声检查作为监测肝硬化患者TIPS术后支架管是否通畅的常规检查手段,CEUS能更加准确的显示支架管闭塞,尤其是CDFI显示支架管血流困难时采用CEUS可明确支架管的通畅情况。

Objective To evaluate the application value of contrast-enhanced ultrasonography （CEUS）in monitoring the stent patency after transjugular intrahepatic portosystemic shunt （TIPS）on patients with cirrhosis .Methods The ultrasonic manifestations of 211 patients with cirrhosis after TIPS in West China Hospital of Sichuan University from January 2012 to October 2012 were analyzed retrospectively . Among these cases ,40 patients underwent CEUS examination ,14 cases were examined by enhanced-CT.The results of enhanced-CT and clinical follow-up were regarded as gold standard to calculate the sensitivity , specificity,positive predictive value and negative predictive value of color doppler flow imaging （CDFI）and CEUS in the diagnosis of stent occlusion after TIPS .Results Two-dimensional ultrasound showed all stents were located between portal vein and inferior vena cava .CDFI showed well-filled blood flow within stent in 171 patients,no blood flow within stent in 38 cases and filling defected blood flow within stent in 2 cases. CEUS showed stents patency in 21 cases,stents occlusion in 17 cases and stents mural thrombosis in 2 cases. Among these 17 cases with stents occlusion diagnosed by CEUS ,3 cases were failed to follow-up and 14 cases underwent enhanced-CT.The results of enhanced-CT showed all stents were occluded .The sensitivity, specificity,positive predictive value and negative predictive value of CDFI in the diagnosis of stent occlusion after TIPS were 100%, 89%, 40% and 100% respectively , and those of CEUS were all 100%. Conclusions CEUS as a conventional examine method in monitoring the stents patency after TIPS on patients with cirrhosis ,it is more accurate than CDFI in the determination of stent occlusion .Using CEUS can definitely diagnose the stent patency especially when CDFI shows blood flow within the stent difficultly .