Abdominal Imaging

, Volume 37, Issue 2, pp 252–260 | Cite as

Contrast-enhanced ultrasound: a new method for TIPS follow-up

  • Capucine Micol
  • Julien Marsot
  • Nawele Boublay
  • Frank Pilleul
  • Yves Berthezene
  • Agnès RodeEmail author



To determine the diagnostic value of contrast-enhanced ultrasound (CEUS) for the detection of TIPS (transjugular intrahepatic portosystemic shunt) complications.

Materials and method

67 cirrhotic patients who underwent TIPS between 2001 and 2008 were retrospectively reviewed. Sixty-two vascular examinations in 37 patients for suspicion of TIPS dysfunction based on the clinical or radiological criteria were analyzed and compared with the 62 related Doppler and CEUS examinations obtained previously. Abnormal CEUS was defined as poor opacification of the prosthesis compared to the native portal vein, stent stenosis, hepatic vein stenosis, and occlusion of the stent.


Among the 62 vascular examinations, 56 were considered as pathologic, including: 20 occlusions, 25 stent stenoses, 9 hepatic vein stenoses, 1 arterial-TIPS fistula, and 1 strong flow stealing through a voluminous paraumbilical vein associated with a patent shunt. 50 were exactly correlated with a previous CEUS examination, including 20/20 occlusions (100%), 23/25 stent stenoses (91%), 5/9 hepatic vein stenoses (56%), 1/1 fistula (100%), and 1/1 strong flow stealing (100%). Two CEUS and 14 Doppler examinations were false negative.


CEUS allows direct visualization of intra-prosthetic flow, with a qualitative and anatomic study, in addition to the Doppler examination. This is a new, simple, and effective technique for TIPS follow-up.

Key words

Contrast-enhanced ultrasound TIPS dysfunction TIPS follow-up Doppler 


  1. 1.
    Richter GM, Noeldge G, Palmaz JC, et al. (1990) Transjugular intrahepatic portacaval stent shunt: preliminary clinical results. Radiology 174:1027–1030PubMedGoogle Scholar
  2. 2.
    Boyer TD (2008) Transjugular intrahepatic portosystemic shunt in the management of complications of portal hypertension. Curr Gastroenterol Rep 10:30–35PubMedCrossRefGoogle Scholar
  3. 3.
    Bilbao JI, Quiroga J, Herrero JI, Benito A (2002) Transjugular intrahepatic portosystemic shunt (TIPS): current status and future possibilities. Cardiovasc Interv Radiol 25:251–269CrossRefGoogle Scholar
  4. 4.
    Rossle M, Deibert P, Haag K, et al. (1997) Randomised trial of transjugular-intrahepatic-portosystemic shunt versus endoscopy plus propranolol for prevention of variceal rebleeding. Lancet 349:1043–1049PubMedCrossRefGoogle Scholar
  5. 5.
    Ochs A, Rossle M, Haag K, et al. (1995) The transjugular intrahepatic portosystemic stent-shunt procedure for refractory ascites. N Engl J Med 332:1192–1197PubMedCrossRefGoogle Scholar
  6. 6.
    Cura M, Cura A, Suri R, et al. (2008) Causes of TIPS dysfunction. AJR Am J Roentgenol 191:1751–1757PubMedCrossRefGoogle Scholar
  7. 7.
    Ducoin H, El-Khoury J, Rousseau H, et al. (1997) Histopathologic analysis of transjugular intrahepatic portosystemic shunts. Hepatology 25:1064–1069PubMedCrossRefGoogle Scholar
  8. 8.
    Latimer J, Bawa SM, Rees CJ, et al. (1998) Patency and reintervention rates during routine TIPSS surveillance. Cardiovasc Interv Radiol 21:234–239CrossRefGoogle Scholar
  9. 9.
    Stanley AJ, Jalan R, Forrest EH, et al. (1996) Longterm follow up of transjugular intrahepatic portosystemic stent shunt (TIPSS) for the treatment of portal hypertension: results in 130 patients. Gut 39:479–485PubMedCrossRefGoogle Scholar
  10. 10.
    Benito A, Bilbao J, Hernandez T, et al. (2004) Doppler ultrasound for TIPS: does it work? Abdom Imaging 29:45–52PubMedCrossRefGoogle Scholar
  11. 11.
    Chong WK, Malisch TA, Mazer MJ, et al. (1993) Transjugular intrahepatic portosystemic shunt: US assessment with maximum flow velocity. Radiology 189:789–793PubMedGoogle Scholar
  12. 12.
    Longo JM, Bilbao JI, Rousseau HP, et al. (1993) Transjugular intrahepatic portosystemic shunt: evaluation with Doppler sonography. Radiology 186:529–534PubMedGoogle Scholar
  13. 13.
    Lafortune M, Martinet JP, Denys A, et al. (1995) Short- and long-term hemodynamic effects of transjugular intrahepatic portosystemic shunts: a Doppler/manometric correlative study. AJR Am J Roentgenol 164:997–1002PubMedGoogle Scholar
  14. 14.
    Foshager MC, Ferral H, Nazarian GK, et al. (1995) Duplex sonography after transjugular intrahepatic portosystemic shunts (TIPS): normal hemodynamic findings and efficacy in predicting shunt patency and stenosis. AJR Am J Roentgenol 165:1–7PubMedGoogle Scholar
  15. 15.
    Dodd GD, 3rd, Zajko AB, Orons PD et al. (1995) Detection of transjugular intrahepatic portosystemic shunt dysfunction: value of duplex Doppler sonography. AJR Am J Roentgenol 164:1119–1124Google Scholar
  16. 16.
    Feldstein VA, Patel MD, LaBerge JM (1996) Transjugular intrahepatic portosystemic shunts: accuracy of Doppler US in determination of patency and detection of stenoses. Radiology 201:141–147PubMedGoogle Scholar
  17. 17.
    Kanterman RY, Darcy MD, Middleton WD, et al. (1997) Doppler sonography findings associated with transjugular intrahepatic portosystemic shunt malfunction. AJR Am J Roentgenol 168:467–472PubMedGoogle Scholar
  18. 18.
    Owens CA, Bartolone C, Warner DL, et al. (1998) The inaccuracy of duplex ultrasonography in predicting patency of transjugular intrahepatic portosystemic shunts. Gastroenterology 114:975–980PubMedCrossRefGoogle Scholar
  19. 19.
    Owens CA (1998) Ultrasound surveillance of tips-why bother? Gastroenterology 114:1433–1434CrossRefGoogle Scholar
  20. 20.
    Zizka J, Elias P, Krajina A, et al. (2000) Value of Doppler sonography in revealing transjugular intrahepatic portosystemic shunt malfunction: a 5-year experience in 216 patients. AJR Am J Roentgenol 175:141–148PubMedGoogle Scholar
  21. 21.
    Carrafiello G (2006) Comparison of contrast-enhanced ultrasound and computed tomography in classifying endoleaks after endovascular treatment of abdominal aorta aneurysms: preliminary experience. Cardiovasc Interv Radiol 29:969–974CrossRefGoogle Scholar
  22. 22.
    Clevert D-A (2007) Imaging of aortic abnormalities with contrast-enhanced ultrasound. A pictorial comparison with CT. Eur Radiol 17:2991–3000PubMedCrossRefGoogle Scholar
  23. 23.
    Bilbao JI, Elorz M, Vivas I, et al. (2004) Transjugular intrahepatic portosystemic shunt (TIPS) in the treatment of venous symptomatic chronic portal thrombosis in non-cirrhotic patients. Cardiovasc Interv Radiol 27:474–480CrossRefGoogle Scholar
  24. 24.
    Lencioni R (2002) Tissue harmonic and contrast-specific imaging: back to gray scale in ultrasound. Eur Radiol 12:151–165PubMedCrossRefGoogle Scholar
  25. 25.
    Lau CT, Scott M, Stavropoulos SW, et al. (2005) Dacron-covered stent-grafts in transjugular intrahepatic portosystemic shunts: initial experience. Radiology 236:725–729PubMedCrossRefGoogle Scholar
  26. 26.
    Foshager MC, Ferral H, Finlay DE, et al. (1994) Color Doppler sonography of transjugular intrahepatic portosystemic shunts (TIPS). AJR Am J Roentgenol 163:105–111PubMedGoogle Scholar
  27. 27.
    Uggowitzer MM, Kugler C, Machan L, et al. (1998) Value of echo-enhanced Doppler sonography in evaluation of transjugular intrahepatic portosystemic shunts. AJR Am J Roentgenol 170:1041–1046PubMedGoogle Scholar
  28. 28.
    Furst G, Malms J, Heyer T, et al. (1998) Transjugular intrahepatic portosystemic shunts: improved evaluation with echo-enhanced color Doppler sonography, power Doppler sonography, and spectral duplex sonography. AJR Am J Roentgenol 170:1047–1054PubMedGoogle Scholar
  29. 29.
    Phillips P, Gardner E (2004) Contrast-agent detection and quantification. Eur Radiol 14(suppl 8):P4–P10PubMedGoogle Scholar
  30. 30.
    Martegani A, Aiani L, Borghi C (2004) The use of contrast-enhanced ultrasound in large vessels. Eur Radiol 14(suppl 8):P73–P86PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Capucine Micol
    • 1
  • Julien Marsot
    • 1
  • Nawele Boublay
    • 2
  • Frank Pilleul
    • 1
  • Yves Berthezene
    • 3
  • Agnès Rode
    • 3
    Email author
  1. 1.Department of RadiologyHôpital E Herriot, Hospices CivilsLyonFrance
  2. 2.Department of Medical Information and Research EvaluationHospices CivilsLyonFrance
  3. 3.Department of RadiologyHôpital Croix-Rousse, Hospices CivilsLyonFrance

Personalised recommendations