Dual Source CT Evaluation of Thrombosis Formation after Transjugular Intrahepatic Portosystemic Shunt_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 PENGLi-qing ¹ , ZHANGXiao ² , HUANGZi-xing ¹ ,  YUJian-qun ¹ , FANGZhi-jia ¹

1. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;
2. CT/MRI Room, Leshan People's Hospital, Leshan 614000, Sichuan Province, China;

Corresponding author：

YUJian-qun, Email: cjr.yujianqun@vip.163.com

Keywords：

Cirrhosis; Portal hypertension; Transjugular intrahepatic portosystemic shunt; Thrombosis

DOI：

10.7507/1007-9424.20160325

Video：

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Objective To evaluate the CT findings and causes of thrombosis formation after transjugular intrahepatic portosystemic shunt (TIPS). Methods One hundred forty-two patients with cirrhosis after TIPS were included. The imaging features of thrombus in the stent after TIPS were recorded and causes of thrombosis formation were analyzed. The presence, location and amount of thrombus, the location of ends of TIPS stent were analyzed. Results The incidence of thrombosis formation after TIPS was 19.0% (27/142). The thrombus could locate around the upper end (7.4%), lower end (18.6%) of the stent and inside the stent (74.0%), there was significant differences in the incidence of stent thrombosis in different locations (P < 0.05). The thrombus might presented as little mural thrombus (12/27, 44.4%), marked thrombus (3/27, 11.1%) and thrombotic occlusion (12/27, 44.4%), there was a significant difference in the incidence of stent thrombosis with different thrombus volume (P < 0.05). There were stent outlet vascular stenosis in most patients with stent thrombosis (88.9%). Conclusions Stent thrombosis after TIPS is common. Dual source computed tomography angiography could evaluate the thrombotic features. Stent outlet vascular stenosis might be associated with thrombosis formation after TIPS.

Citation： PENG Li-qing, ZHANG Xiao, HUANG Zi-xing, YU Jian-qun, FANG Zhi-jia. Dual Source CT Evaluation of Thrombosis Formation after Transjugular Intrahepatic Portosystemic Shunt. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(10): 1268-1271. doi: 10.7507/1007-9424.20160325 Copy

1.	Heinzow HS,Lenz P,Köhler M,et al. Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis. World J Gastroenterol,2012, 18(37):5211-5218.
2.	Kim HK,Kim YJ,Chung WJ, et al. Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension:Korean multicenter real-practice data. Clin Mol Hepatol,2014,20(1):18-27.
3.	韩浩, 杨建, 诸葛宇征, 等. 彩色多普勒超声对经颈静脉肝内门体分流术后支架功能障碍的诊断价值. 临床超声医学杂志, 2015, 17(8):522-525.
4.	Peng LQ, Yu JQ, Yang ZG, et al. Left atrial diverticula in patients referred for radiofrequency ablation of atrial fibrillation:assessment of prevalence and morphologic characteristics by dual-source computed tomography. Circ Arrhythm Electrophysiol, 2012, 5(2):345-350.
5.	王荣品, 刘昌杰, 邓奇平, 等. 双源CT一站式扫描诊断急性肺栓塞与深静脉血栓. 中国医学影像技术, 2011, 27(12):2476-2479.
6.	张青, 鲜军舫, 燕飞, 等. CT增强扫描评价急慢性门静脉系统血栓. 临床荟萃, 2014, 29(6):651-657.
7.	陈志明, 吕梁, 李文佳, 等. 双源CT在经颈静脉门腔分流术后随访中的应用. 中国医学影像技术, 2011, 27(8):1626-1628.
8.	褚建国, 黄鹤. 经颈静脉肝内门腔静脉支架分流术中门静脉分流支血管的选择及其临床意义. 中华介入放射学电子杂志, 2013, 1(1):36-39.
9.	Geeroms B, Laleman W, Laenen A, et al. Expanded polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunts in cirrhotic patients:long-term patency and clinical outcome results. Eur Radiol, 2016 Sep 15.[Epub ahead of print].
10.	Menichini C, Xu XY. Mathematical modeling of thrombus formation in idealized models of aortic dissection:initial findings and poten tial applications. J Math Biol, 2016 Mar 23.[Epub ahead of print].
11.	Ho H, Sorrell K, Peng L, et al. Hemodynamic analysis for transjugular intrahepatic portosystemic shunt (TIPS) in the liver based on a CT-image. IEEE Trans Med Imaging, 2013, 32(1):92-98.
12.	Janiga G, Daróczy L, Berg P, et al. An automatic CFD-based flow diverter optimization principle for patient-specific intracranial aneurysms. J Biomech. 2015, 48(14):3846-3852.
13.	Landgraf BR, Johnson KM, Roldán-Alzate A, et al. Effect of temporal resolution on 4D flow MRI in the portal circulation. J Magn Reson Imaging, 2014, 39(4):819-826.
14.	周洪煜, 公丕运, 杜学森, 等. 脾静脉血栓对血流动力学影响的分析及计算流体力学模拟. 生物医学工程学杂志, 2015, 32(1):43-47.
15.	George SM, Eckert LM, Martin DR, et al. Hemodynamics in normal and diseased livers:application of image-based computational models. Cardiovasc Eng Technol, 2015, 6(1):80-91.
16.	Li X, Wang XK, Chen B, et al. Computational hemodynamics of portal vein hypertension in hepatic cirrhosis patients. Biomed Mater Eng, 2015, 26 Suppl 1:S233-S243.
17.	Ho H, Bartlett A, Hunter P. Hemodynamic simulation for an anatomically realistic portal system. Med Image Comput Comput Assist Interv, 2011, 14(Pt 1):347-354.
18.	Balasubramanian P, Boopathy V, Govindasamy E, et al. Assessment of portal venous and hepatic artery haemodynamic variation in non-alcoholic fatty liver disease (NAFLD) patients. J Clin Diagn Res, 2016, 10(8):TC07-TC10.
19.	Owens CA,Bartolone C,Warner DL, et al. The inaccuracy of duplex ultrasonography in predicting patency of transjugular intrahepatic portosystemic shunts.Gastroenterology, 1998, 114(5):975-980.
20.	Benito A,Bilbao J,Hernández T, et al. Doppler ultrasound for TIPS:does it work? Abdom Imaging, 2004, 29(1):45-52.
21.	韩浩,杨建,吴敏,等. 经颈静脉肝内门体分流术对门静脉血流动力学变化的超声评价.江苏医药, 2014, 40(8):970-971.
22.	陈家飞, 李莲, 李荣军. 3D旋转DSA在TIPS中的临床应用. 局解手术学杂志, 2011, 20(5):588.
23.	Flohr TG, Leng S, Yu L, et al. Dual-source spiral CT with pitch up to 3.2 and 75 ms temporal resolution:image reconstruction and assessment of image quality. Med Phys, 2009, 36(12):5641-5653.
24.	朱洪基, 余建群, 彭礼清,等. 小儿急性阑尾炎的双源CT评价. 中国普外基础与临床杂, 2015, 22(07):875-878.
25.	钱蓉, 袁元, 黄子星, 等. 双源CT双能量扫描碘图对急性胰腺炎早期坏死灶的诊断价值.中国普外基础与临床杂志, 2015, 22(3):357-360.
26.	袁元, 李真林, 杨行, 等. 双源CT低剂量扫描在上腹部增强检查中的应用. 中国普外基础与临床杂志, 2012, 19(5):556-561.

1. Heinzow HS,Lenz P,Köhler M,et al. Clinical outcome and predictors of survival after TIPS insertion in patients with liver cirrhosis. World J Gastroenterol,2012, 18(37):5211-5218.
2. Kim HK,Kim YJ,Chung WJ, et al. Clinical outcomes of transjugular intrahepatic portosystemic shunt for portal hypertension:Korean multicenter real-practice data. Clin Mol Hepatol,2014,20(1):18-27.
3. 韩浩, 杨建, 诸葛宇征, 等. 彩色多普勒超声对经颈静脉肝内门体分流术后支架功能障碍的诊断价值. 临床超声医学杂志, 2015, 17(8):522-525.
4. Peng LQ, Yu JQ, Yang ZG, et al. Left atrial diverticula in patients referred for radiofrequency ablation of atrial fibrillation:assessment of prevalence and morphologic characteristics by dual-source computed tomography. Circ Arrhythm Electrophysiol, 2012, 5(2):345-350.
5. 王荣品, 刘昌杰, 邓奇平, 等. 双源CT一站式扫描诊断急性肺栓塞与深静脉血栓. 中国医学影像技术, 2011, 27(12):2476-2479.
6. 张青, 鲜军舫, 燕飞, 等. CT增强扫描评价急慢性门静脉系统血栓. 临床荟萃, 2014, 29(6):651-657.
7. 陈志明, 吕梁, 李文佳, 等. 双源CT在经颈静脉门腔分流术后随访中的应用. 中国医学影像技术, 2011, 27(8):1626-1628.
8. 褚建国, 黄鹤. 经颈静脉肝内门腔静脉支架分流术中门静脉分流支血管的选择及其临床意义. 中华介入放射学电子杂志, 2013, 1(1):36-39.
9. Geeroms B, Laleman W, Laenen A, et al. Expanded polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunts in cirrhotic patients:long-term patency and clinical outcome results. Eur Radiol, 2016 Sep 15.[Epub ahead of print].
10. Menichini C, Xu XY. Mathematical modeling of thrombus formation in idealized models of aortic dissection:initial findings and poten tial applications. J Math Biol, 2016 Mar 23.[Epub ahead of print].
11. Ho H, Sorrell K, Peng L, et al. Hemodynamic analysis for transjugular intrahepatic portosystemic shunt (TIPS) in the liver based on a CT-image. IEEE Trans Med Imaging, 2013, 32(1):92-98.
12. Janiga G, Daróczy L, Berg P, et al. An automatic CFD-based flow diverter optimization principle for patient-specific intracranial aneurysms. J Biomech. 2015, 48(14):3846-3852.
13. Landgraf BR, Johnson KM, Roldán-Alzate A, et al. Effect of temporal resolution on 4D flow MRI in the portal circulation. J Magn Reson Imaging, 2014, 39(4):819-826.
14. 周洪煜, 公丕运, 杜学森, 等. 脾静脉血栓对血流动力学影响的分析及计算流体力学模拟. 生物医学工程学杂志, 2015, 32(1):43-47.
15. George SM, Eckert LM, Martin DR, et al. Hemodynamics in normal and diseased livers:application of image-based computational models. Cardiovasc Eng Technol, 2015, 6(1):80-91.
16. Li X, Wang XK, Chen B, et al. Computational hemodynamics of portal vein hypertension in hepatic cirrhosis patients. Biomed Mater Eng, 2015, 26 Suppl 1:S233-S243.
17. Ho H, Bartlett A, Hunter P. Hemodynamic simulation for an anatomically realistic portal system. Med Image Comput Comput Assist Interv, 2011, 14(Pt 1):347-354.
18. Balasubramanian P, Boopathy V, Govindasamy E, et al. Assessment of portal venous and hepatic artery haemodynamic variation in non-alcoholic fatty liver disease (NAFLD) patients. J Clin Diagn Res, 2016, 10(8):TC07-TC10.
19. Owens CA,Bartolone C,Warner DL, et al. The inaccuracy of duplex ultrasonography in predicting patency of transjugular intrahepatic portosystemic shunts.Gastroenterology, 1998, 114(5):975-980.
20. Benito A,Bilbao J,Hernández T, et al. Doppler ultrasound for TIPS:does it work? Abdom Imaging, 2004, 29(1):45-52.
21. 韩浩,杨建,吴敏,等. 经颈静脉肝内门体分流术对门静脉血流动力学变化的超声评价.江苏医药, 2014, 40(8):970-971.
22. 陈家飞, 李莲, 李荣军. 3D旋转DSA在TIPS中的临床应用. 局解手术学杂志, 2011, 20(5):588.
23. Flohr TG, Leng S, Yu L, et al. Dual-source spiral CT with pitch up to 3.2 and 75 ms temporal resolution:image reconstruction and assessment of image quality. Med Phys, 2009, 36(12):5641-5653.
24. 朱洪基, 余建群, 彭礼清,等. 小儿急性阑尾炎的双源CT评价. 中国普外基础与临床杂, 2015, 22(07):875-878.
25. 钱蓉, 袁元, 黄子星, 等. 双源CT双能量扫描碘图对急性胰腺炎早期坏死灶的诊断价值.中国普外基础与临床杂志, 2015, 22(3):357-360.
26. 袁元, 李真林, 杨行, 等. 双源CT低剂量扫描在上腹部增强检查中的应用. 中国普外基础与临床杂志, 2012, 19(5):556-561.

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Dual Source CT Evaluation of Thrombosis Formation after Transjugular Intrahepatic Portosystemic Shunt

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