Effects of TIPS on Liver Perfusion Measured by Dynamic CT

• Published in: American journal of roentgenology (1976) Vol. 184; no. 2; pp. 505 - 510
• Main Authors: Weidekamm, Claudia, Cejna, Manfred, Kramer, Ludwig, Peck-Radosavljevic, Markus, Bader, Till R
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.02.2005; American Roentgen Ray Society
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Contrast Media; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Investigative techniques, diagnostic techniques (general aspects); Linear Models; Liver Circulation - physiology; Liver Cirrhosis - diagnostic imaging; Liver Cirrhosis - surgery; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Portasystemic Shunt, Transjugular Intrahepatic; Radiography, Interventional; Reference Values; Tomography, X-Ray Computed; Nuclear medicine; Intravenous administration; Liver; Parenchyma; Hepatic disease; Intrahepatic portosystemic shunt; Density; Interest; Tissue; Aorta; Human; Spleen; Program; Radiodiagnosis; Healthy subject; Method; Normal; Biological activity; Cirrhosis; Perfusion; Radiology; Value; Digestive diseases; Medical imagery; Computerized axial tomography; Portal vein; Comparative study
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.184.2.01840505

Our aim was to measure the arterial, portal venous, and total perfusion of the liver parenchyma with dynamic, single-section CT in patients with liver cirrhosis before and after transjugular intrahepatic portosystemic shunt (TIPS) placement and to compare the results with normal values. Perfusion of the liver parenchyma was measured in 24 healthy volunteers and 41 patients with liver cirrhosis using dynamic single-section CT. Seventeen patients underwent TIPS placement, and CT measurements were repeated within 7 days. CT scans were obtained at a single level comprising the liver, spleen, aorta, and portal vein. Scans were obtained over a period of 88 sec (one baseline scan followed by 16 scans every 2 sec and eight scans every 7 sec) beginning with the injection of a contrast agent bolus (40 mL at 10 mL/sec). Parenchymal and vascular contrast enhancement was measured with regions of interest, and time-density curves were obtained. These data were processed with a pharmaco-dynamic fitting program (TopFit), and the arterial and portal venous component and the total perfusion of the hepatic parenchyma were calculated (milliliters of perfusion per minute per 100 mL of tissue). Mean normal values for hepatic arterial, portal venous, and total perfusion were 20, 102, and 122 mL/min per 100 mL, respectively. In patients with cirrhosis before TIPS, mean hepatic arterial, portal venous, and total perfusion was 28, 63, and 91 mL/min per 100 mL, respectively, which was statistically significant for all values (p <0.05). After TIPS, hepatic perfusion increased to a mean value of 48, 65, 113 mL/min per 100 mL for arterial (p <0.01), portal venous, and total (p=0.011) perfusion, respectively. In patients with cirrhosis, the hepatic arterial perfusion increased, whereas portal venous and total perfusion decreased compared with that of healthy volunteers. TIPS placement caused a statistically significant increase of the hepatic arterial and total hepatic perfusion. The portal venous parenchymal perfusion remained unchanged.