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Abdominal Radiology

, Volume 44, Issue 7, pp 2392–2402 | Cite as

Performance of ultrasound for detection of transjugular intrahepatic portosystemic shunt dysfunction: a meta-analysis

  • Wuttiporn ManatsathitEmail author
  • Hrishikesh Samant
  • Panadeekarn Panjawatanan
  • Annie Braseth
  • Jane Suh
  • Mohammad Esmadi
  • Noah Wiedel
  • Thammasin Ingviya
Review
  • 85 Downloads

Abstract

Purpose

Although ultrasound has been widely used to evaluate transjugular intrahepatic portosystemic shunts (TIPS) patency, several studies have reported conflicting data regarding its performance. Therefore, we aimed to evaluate performance of ultrasound for detection of TIPS dysfunction by performing a meta-analysis.

Methods

Literature search was performed for studies evaluating ultrasound for TIPS dysfunction, stenosis, and occlusion using PubMed, EMBASE, Scopus, and Cochrane Library through February 2019. Pooled sensitivity, specificity, log diagnostic odds ratio (LDOR), and area under curve (AUC) of summary receiver-operating characteristic were calculated. Subgroup analyses were performed according to ultrasonographic criteria and type of stent.

Results

In total, 21 studies were evaluated. Pooled sensitivity, specificity, and LDOR of ultrasound for detection of TIPS dysfunction were 0.82 (0.67, 0.93), 0.58 (0.46, 0.70), and 1.77 (1.20, 2.35). Pooled sensitivity, specificity, and LDOR for TIPS stenosis were 0.80 (0.69, 0.90), 0.80 (0.69, 0.91), and 2.83 (1.88, 3.78). Pooled sensitivity, specificity, and LDOR for TIPS occlusion were 0.96 (0.92, 0.99), 1 (0.99, 1.00), and 6.28 (4.96, 7.60). AUCs of ultrasound for TIPS dysfunction, stenosis, and occlusion were 0.77, 0.86, and 0.95, respectively.

Conclusions

Although ultrasound had excellent performance for TIPS occlusion and acceptable performance for TIP stenosis, most studies utilized bare metal stent, and therefore, application to current practice is limited. Ultrasound for TIPS dysfunction in the setting of covered metal stent appeared to have acceptable sensitivity of 0.82, but limited specificity of 0.58 and low LDOR of 1.77. A new noninvasive tool is needed for detection of TIPS dysfunction in the era of covered metal stent.

Keywords

Transjugular intrahepatic portosystemic shunt Stents Doppler ultrasonography Cirrhosis Portal hypertension 

Notes

Acknowledgements

The authors would like to thank Roxanne Cox, MLS, McGoogan of the Library of Medicine, University of Nebraska Medical Center who provided advices and assisted in the literature search.

Author contributions

WM, HS, and PP participated in the study design. Data extraction was performed by WM and PP, while quality assessment was performed by ME and NW. TI performed statistical analyses. WM, JS, and AB participated in the manuscript preparation.

Compliance with ethical standards

Conflict of interest

This study was not supported by funding or grant. All authors have no financial disclosure.

Supplementary material

261_2019_1981_MOESM1_ESM.tif (1.4 mb)
Supplementary material 1 (TIFF 1400 kb) Supplementary Fig. 1: Pooled sensitivity of studies evaluating performance of ultrasound for TIPS dysfunction
261_2019_1981_MOESM2_ESM.tif (872 kb)
Supplementary material 2 (TIFF 872 kb) Supplementary Fig. 2: Pooled specificity of studies evaluating performance of ultrasound for TIPS dysfunction
261_2019_1981_MOESM3_ESM.tif (978 kb)
Supplementary material 3 (TIFF 977 kb) Supplementary Fig. 3: LDOR of studies evaluating performance of ultrasound for TIPS dysfunction
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Supplementary material 4 (TIFF 7705 kb) Supplementary Fig. 4: Pooled sensitivity of studies evaluating performance of ultrasound for TIPS stenosis
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Supplementary material 5 (TIFF 7705 kb) Supplementary Fig. 5: Pooled specificity of studies evaluating performance of ultrasound for TIPS stenosis
261_2019_1981_MOESM6_ESM.tiff (7.5 mb)
Supplementary material 6 (TIFF 7706 kb) Supplementary Fig. 6: LDOR of studies evaluating performance of ultrasound for TIPS stenosis
261_2019_1981_MOESM7_ESM.tiff (7.6 mb)
Supplementary material 7 (TIFF 7791 kb) Supplementary Fig. 7: Pooled sensitivity of studies evaluating performance of ultrasound for TIPS occlusion
261_2019_1981_MOESM8_ESM.tiff (7.6 mb)
Supplementary material 8 (TIFF 7790 kb) Supplementary Fig. 8: Pooled specificity of studies evaluating performance of ultrasound for TIPS occlusion
261_2019_1981_MOESM9_ESM.tiff (7.6 mb)
Supplementary material 9 (TIFF 7791 kb) Supplementary Fig. 9: LDOR of studies evaluating performance of ultrasound for TIPS occlusion
261_2019_1981_MOESM10_ESM.docx (33 kb)
Supplementary material 10 (DOCX 33 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Wuttiporn Manatsathit
    • 1
    Email author
  • Hrishikesh Samant
    • 2
  • Panadeekarn Panjawatanan
    • 3
  • Annie Braseth
    • 4
  • Jane Suh
    • 1
  • Mohammad Esmadi
    • 5
  • Noah Wiedel
    • 4
  • Thammasin Ingviya
    • 6
  1. 1.Division of Gastroenterology and HepatologyUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Division of GastroenterologyLouisiana State University Health Science CenterShreveportUSA
  3. 3.Department of BiochemistryChiang Mai UniversityChiang MaiThailand
  4. 4.Department of Internal MedicineUniversity of Nebraska Medical CenterOmahaUSA
  5. 5.Department of Internal MedicineMethodist Physicians ClinicCouncil BluffsUSA
  6. 6.Department of Family Medicine and Preventive MedicinePrince of Songkhla UniversitySongkhlaThailand

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