THE INACCURACY OF DUPLEX ULTRASONOGRAPHY IN PREDICTING PATENCY OF TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC SHUNTS

Background & Aims: A prospective double-blinded study with preset sono graphic criteria has not been performed to assess the accuracy of dupl ex ultrasonography in determining the patency of transjugular intrahep atic portosystemic shunts (TIPS). The purpose of this study was to det ermine the sensitivity and specificity of duplex ultrasonography in pr edicting shunt malfunction using accepted preset sonographic criteria. Methods: Sixty ultrasonographic and venographic follow-up comparisons were made on 38 cirrhotic patients who had undergone TIPS placement f or variceal bleeding (n = 28) or intractable ascites (n = 10). Ultraso nographic results were analyzed by one of two board-certified ultrason ographers without knowledge of venographic findings. Results: Of the 3 1 occluded (n = 8) and stenotic (n = 23) shunts, ultrasonography accur ately predicted a shunt malfunction (occlusion or stenosis) in only 11 studies and incorrectly predicted patency in 20. Compared with venogr aphy, ultrasonography had a sensitivity of 35% and a specificity of 83 % in predicting TIPS stenosis or occlusion. Conclusions: These results suggest that duplex sonography is not a sensitive test in predicting the presence of a hemodynamically significant stenosis and that shunt status should be assessed by venography and direct portal pressure mea surements until a more reliable and proven noninvasive ultrasonographi c criterion is devised.