COMPARISON OF ULTRASOUND, CT, AND MR-IMAGING IN THE EVALUATION OF CANDIDATES FOR TIPS

To compare ultrasound (US), CT, and MRI in the evaluation of hepatic v ascular anatomy, portal and splenic venous flow, and collateral pathwa ys (varices and spontaneous shunts) in candidates for transjugular int rahepatic portosystemic shunting (TIPS), 17 patients with history of r efractory variceal bleeding or intractable ascites underwent duplex US , contrast-enhanced CT, and MRI before TIPS, The appearance of portal and hepatic anatomy was graded from 1 (not visible) to 4 (excellent vi sualization) independently by four radiologists, Presence and directio n of portal and splenic venous now, and presence and location of varic es and spontaneous portosystemic shunts were also assessed, Results an d effects of interobserver variation were assessed for significance us ing Friedman's ANOVA and Wilcoxon's signed-rank test, MRI yielded high er scores than CT or US for hepatic veins (P<.0001) and inferior vena cava (P<.0001), MRI and CT scored better than US for portal vein branc hes (P=.012) and splenic vein (P=.0038), All tests demonstrated the ma in portal vein well, with no statistically significant difference, US and MRI were more sensitive than CT for detecting portal vein flow and direction (US 76%, CT 0%, MRI 82%), MRI was most sensitive for spleni c vein flow and direction (US 41%, CT 0%, MRI 76%), CT and MRI were mo re sensitive than US in detecting varices (US 5%, CT 50%, MRI 58%) and spontaneous shunts (US 13%, CT 75%, MRI 75%), Interobserver variation did not influence results significantly P=.3691), MRI provides the mo st useful information and may be the preferred single imaging test pri or to TIPS.