MR ANGIOGRAPHIC GUIDANCE FOR TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNT PROCEDURES

The authors used magnetic resonance (MR) angiography to guide catheter placement in transjugular intrahepatic portosystemic shunt (TIPS) pro cedures in nine of 18 patients and compared the results with those of the nine patients for whom prior planning based on MR angiography was not done. Two-dimensional time-of-flight MR venography was performed d uring breath hold, and projection venograms were formatted in sagittal , coronal, and axial planes. MR angiography defined venous anatomy suf ficiently to shorten the procedure and help minimize invasiveness. Wit h MR angiographic guidance, intrahepatic needle punctures were signifi cantly fewer (without MR guidance: mean, 12.1; with MR guidance: mean, 3.6; P < .001) and associated complications were absent (without MR g uidance: failed placement, n = 1; bleeding requiring blood transfusion s, n = 1; death due to intraperitoneal hemorrhage with hemobilia, n = 1; and death due to hepatic capsular perforation, n = 1). The average time for the procedure was 2.9 hours without MR angiographic guidance and 1.8 hours with MR angiographic guidance (P < .001). The authors co nclude that MR angiography is a useful technique for defining portal a nd hepatic venous anatomy before the TIPS procedure and that planning based on MR angiography may decrease the difficulty and length of the procedure.