Stephen Z Pinter1, Jonathan M Rubin1, Oliver D Kripfgans2, Paula M Novelli1, Mario Vargas-Vila1, Anne L Hall1, J Brian Fowlkes1. 1. Department of Radiology, University of Michigan, Ann Arbor, Michigan USA (S.Z.P., J.M.R., O.D.K., P.M.N., M.V.-V., J.B.F.); and GE Healthcare, Milwaukee, Wisconsin USA (A.L.H.). 2. Department of Radiology, University of Michigan, Ann Arbor, Michigan USA (S.Z.P., J.M.R., O.D.K., P.M.N., M.V.-V., J.B.F.); and GE Healthcare, Milwaukee, Wisconsin USA (A.L.H.). oliver.kripfgans@umich.edu.
Abstract
OBJECTIVES: Three-dimensional (3D)/4-dimensional (4D) sonographic measurement of blood volume flow in transjugular intrahepatic porto systemic shunt revision with the intention of objective assessment of shunt patency. METHODS: A total of 17 patients were recruited (12 male and 5 female; mean age, 55 years; range, 30-69 years). An ultrasound system equipped with a 2.0-5.0-MHz probe was used to acquire multivolume 3D/4D color Doppler data sets to assess prerevision and postrevision shunt volume flow. Volume flow was computed offline based on the principle of surface integration of Doppler-measured velocity vectors in a lateral-elevational c-surface positioned at the color flow focal depth (range, 8.0-11.5 cm). Volume flow was compared to routine measurements of the prerevision and postrevision portosystemic pressure gradient. Prerevision volume flow was compared with the outcome to determine whether a flow threshold for revision could be defined. RESULTS: Linear regression of data from revised transjugular intrahepatic portosystemic shunt cases showed an inverse correlation between the mean-normalized change in prerevision and postrevision shunt volume flow and the mean-normalized change in the prerevision and postrevision portosystemic pressure gradient (r(2) = 0.51; P = .020). Increased shunt blood flow corresponded to a decreased pressure gradient. Comparison of prerevision flows showed preliminary threshold development at 1534 mL/min, below which a shunt revision may be recommended (P = .21; area under the receiver operating characteristic curve = 0.78). CONCLUSIONS: Shunt volume flow measurement with 3D/4D Doppler sonography provides a potential alternative to standard pulsed wave Doppler metrics as an indicator of shunt function and predictor of revision.
OBJECTIVES: Three-dimensional (3D)/4-dimensional (4D) sonographic measurement of blood volume flow in transjugular intrahepatic porto systemic shunt revision with the intention of objective assessment of shunt patency. METHODS: A total of 17 patients were recruited (12 male and 5 female; mean age, 55 years; range, 30-69 years). An ultrasound system equipped with a 2.0-5.0-MHz probe was used to acquire multivolume 3D/4D color Doppler data sets to assess prerevision and postrevision shunt volume flow. Volume flow was computed offline based on the principle of surface integration of Doppler-measured velocity vectors in a lateral-elevational c-surface positioned at the color flow focal depth (range, 8.0-11.5 cm). Volume flow was compared to routine measurements of the prerevision and postrevision portosystemic pressure gradient. Prerevision volume flow was compared with the outcome to determine whether a flow threshold for revision could be defined. RESULTS: Linear regression of data from revised transjugular intrahepatic portosystemic shunt cases showed an inverse correlation between the mean-normalized change in prerevision and postrevision shunt volume flow and the mean-normalized change in the prerevision and postrevision portosystemic pressure gradient (r(2) = 0.51; P = .020). Increased shunt blood flow corresponded to a decreased pressure gradient. Comparison of prerevision flows showed preliminary threshold development at 1534 mL/min, below which a shunt revision may be recommended (P = .21; area under the receiver operating characteristic curve = 0.78). CONCLUSIONS: Shunt volume flow measurement with 3D/4D Doppler sonography provides a potential alternative to standard pulsed wave Doppler metrics as an indicator of shunt function and predictor of revision.
Authors: Oliver D Kripfgans; Jonathan M Rubin; Stephen Z Pinter; James Jago; Ron Leichner; J Brian Fowlkes Journal: IEEE Trans Ultrason Ferroelectr Freq Control Date: 2019-08-09 Impact factor: 2.725
Authors: Oliver D Kripfgans; Stephen Z Pinter; Cristel Baiu; Matthew F Bruce; Paul L Carson; Shigao Chen; Todd N Erpelding; Jing Gao; Mark E Lockhart; Andy Milkowski; Nancy Obuchowski; Michelle L Robbin; Jonathan M Rubin; James A Zagzebski; J Brian Fowlkes Journal: Radiology Date: 2020-06-30 Impact factor: 11.105
Authors: Peter Bannas; Alejandro Roldán-Alzate; Kevin M Johnson; Michael A Woods; Orhan Ozkan; Utaroh Motosugi; Oliver Wieben; Scott B Reeder; Harald Kramer Journal: Radiology Date: 2016-05-12 Impact factor: 11.105
Authors: Jonathan M Rubin; Sibo Li; J Brian Fowlkes; Shriram Sethuraman; Oliver D Kripfgans; William Shi; Marjorie C Treadwell; James R Jago; Ronald D Leichner; Stephen Z Pinter Journal: J Ultrasound Med Date: 2020-08-07 Impact factor: 2.153