Abstract:
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Purpose: To assess the efficacy of multidetector-row CT (MDCT) in the detection of TIPS malfunction, performed with e-PTFE covered stent-graft, in order to avoid the difficulties of Ultrasound-Color-Doppler (USCD) in stent-graft evaluation.
Methods and Materials: Eighty-five patients underwent a TIPS procedure with a new e-PTFE stent-graft: Viatorr (W.L. Gore). Patients were followed-up with USCD and MDCT at 3-6-12 months; in case of abnormal findings a portogram and/or intravascular ultrasound (IVUS) were also performed. MDCT was done using a multidetector scan (Somatom Volume Zoom,Siemens) at the level of the upper abdomen with 5 mm slice thickness (2.5mm collimation, 5mm reconstruction interval); after intravenous administration of 150 ml of iodinated contrast media at 4 ml/s, arterial (30 sec delay-3mm slice thickness-2.5mm collimation-1mm reconstruction interval) and venous (60 sec delay-1.25mm slice thickness-1mm collimation-1mm reconstruction interval) phases were acquired. Multiplanar reconstructions of the images were performed with a dedicated workstation (Vitrea-Vital Images).
Results: MDCT was successfully performed in all cases, analysing stent-graft position, shunt patency, hepatic veins and portal vein. Correlation of shunt patency or malfunction between MDCT and USCD was observed in 80/85 patients (94.2%). In 5 cases (5.8%) MDCT indicated the completely shunt patency, not correlate with USCD that showed a mild stenosis of the shunt. Conventional venography and IVUS were then performed confirming the patency of the stent-graft according to the MDCT. Stenosis of the hepatic vein (n=8) and of the portal vein (n=4) were correctly diagnosed by MDCT and confirmed with venography and intravascular ultrasound. MDCT demonstrated the complete patency of the shunt in 66 patients and shunt occlusion in 2 cases; these data were also evidentiated by USCD and venography.
Conclusion: With the routinely use of e-PTFE covered stent-graft in TIPS, to prolong shunt patency, several difficulties were reported, during follow-up, using Ultrasound-Color-Doppler. MDCT seems to be a safe and accurate method in the evaluation of stent-graft patency.
Questions about this event email: fabrizio.fanelli@uniroma1.it
Fanelli MD, F,
Use of Multidetector-row CT for the Evaluation of E-PTFE Covered Stent in TIPS. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3107768.html
