SCINTIGRAPHIC EVALUATION OF HEPATIC BLOOD-FLOW AFTER INTRAHEPATIC PORTOSYSTEMIC SHUNT (TIPS)

In patients with liver cirrhosis a transjugularly placed intrahepatic portocaval shunt (TIPS) is a non-surgical portosystemic device which a ims to reduce portal venous pressure. In comparison with Doppler sonog raphy, we evaluated in 28 patients the diagnostic impact of liver perf usion scintigraphy (with technetium-99m diethylene triamine penta-acet ic acid) in the assessment of changes in the hepatic blood flow after TIPS shunting. The arterial and portal contributions to hepatic flow w ere calculated from the areas under the biphasic time-activity curve. In the course of TIPS shunting, patency is threatened by reocclusion. Angiography is the gold standard for TIPS shunt reassessment. However, there is a need for a less invasive diagnostic procedure, such as sci ntigraphy or Doppler sonography, for the early detection of shunt insu fficiency. Scintigraphy demonstrated that prior to TIPS shunting the p ortal venous contribution to hepatic perfusion was reduced to 29.2%, t his reduction being due to portal hypertension. After TIPS placement a significant increase in portal venous perfusion was observed (38.2%; P < 0.02), TIPS shunt occlusion was identified in patients by a signif icant reduction in the scintigraphically measured portal venous contri bution to hepatic blood flow. Hepatic perfusion scintigraphy appears t o be a valuable method to determine the immediate effect of TIPS on he patic blood flow, Post-TIPS follow-up studies of hepatic haemodynamics by liver perfusion scintigraphy appear able to contribute to the dete ction of TIPS shunt occlusion before the clinical consequences of this complication have become apparent.