Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Sep 28, 2017; 9(27): 1125-1132
Published online Sep 28, 2017. doi: 10.4254/wjh.v9.i27.1125
Evaluation of Doppler-ultrasonography in the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction: A prospective study
Charlotte Nicolas, Amélie Le Gouge, Louis d’Alteroche, Jean Ayoub, Monica Georgescu, Vincent Vidal, Denis Castaing, Jean-Pierre Cercueil, Patrick Chevallier, Jérôme Roumy, Hervé Trillaud, Louis Boyer, Vincent Le Pennec, Christophe Perret, Bruno Giraudeau, Jean-Marc Perarnau, STIC-TIPS group
Charlotte Nicolas, Louis d’Alteroche, Jean-Marc Perarnau, Service d’Hépato-Gastroentérologie, Hôpital Trousseau, CHRU Tours, 37044 Tours, France
Amélie Le Gouge, Bruno Giraudeau, CIC, CHRU de Tours, 37044 Tours, France
Amélie Le Gouge, Bruno Giraudeau, INSERM, CIC 202, 37044 Tours, France
Jean Ayoub, Monica Georgescu, Unité d’échographie-doppler, Hôpital Trousseau, CHRU Tours, 37044 Tours, France
Vincent Vidal, Service de Radiologie, Hôpital de la Timone, 13385 Marseille, France
Denis Castaing, Centre Hépato-Biliaire, Hôpital Paul Brousse, 94800 Villejuif, France
Jean-Pierre Cercueil, Service de Radiologie, CHRU Dijon, 21000 Dijon, France
Patrick Chevallier, Service d’Imagerie Médicale Diagnostique et interventionnelle Hôpital de l’Archet II Nice, 06200 Nice, France
Jérôme Roumy, Service de Radiologie et Echographie, CHRU Poitiers, 86021 Poitiers, France
Hervé Trillaud, Service d’Imagerie Médicale Hôpital Saint André, CHRU Bordeaux, 33000 Bordeaux, France
Louis Boyer, Service d’Imagerie viscérale et vasculaire, CHRU Clermont Ferrand, 63003 Clermont Ferrand, France
Vincent Le Pennec, Service de Radiologie, CHRU Caen, 14033 Caen, France
Christophe Perret, Service de Radiologie, CHRU Nantes, 44000 Nantes, France
Author contributions: Nicolas C drafted the manuscript, and assisted with data analysis; Le Gouge A participated in design of the study and performed statistical analysis; d’Alteroche L participated in design and oversight of the study; Ayoub J, Georgescu M, Vidal V, Castaing D, Cercueil JP, Chevallier P, Roumy J, Trillaud H, Boyer L, Le Pennec V and Perret C were involved with data collection; Giraudeau B assisted with data analysis; Perarnau JM drafted the manuscript, participated in design and oversight of the study; the STIC TIPS group was involved with data collection.
Supported by Innovative techniques support of French Ministry of Health STIC 07 and the Société Nationale Française de Gastroentérologie.
Institutional review board statement: This study was reviewed and approved by the ethical committee CPPRB of Tours (France).
Clinical trial registration statement: This study is registered with The registration identification number is 00593528.
Informed consent statement: All study participants provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript having no conflicts of interest to disclose.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Charlotte Nicolas, MD, Service d’Hépato-Gastroentérologie, Hôpital Trousseau, CHRU Tours, Cedex 9, 37044 Tours, France.
Telephone: +33-247-475965 Fax: +33-247-478428
Received: January 28, 2017
Peer-review started: February 7, 2017
First decision: April 1, 2017
Revised: July 20, 2017
Accepted: September 5, 2017
Article in press: September 5, 2017
Published online: September 28, 2017

To prospectively evaluate the performance of Doppler-ultrasonography (US) for the detection of transjugular intrahepatic portosystemic shunt (TIPS) dysfunction within a multicenter cohort of cirrhotic patients.


This study was conducted in 10 french teaching hospitals. After TIPS insertion, angiography and liver Doppler-US were carried out every six months to detect dysfunction (defined by a portosystemic gradient ≥ 12 mmHg and/or a stent stenosis ≥ 50%). The association between ultrasonographic signs and dysfunction was studied by logistic random-effects models, and the diagnostic performance of each Doppler criterion was estimated by the bootstrap method. This study was approved by the ethics committee of Tours.


Two hundred and eighteen pairs of examinations performed on 87 cirrhotic patients were analyzed. Variables significantly associated with dysfunction were: The speed of flow in the portal vein (P = 0.008), the reversal of flow in the right (P = 0.038) and left (P = 0.049) portal branch, the loss of modulation of portal flow by the right atrium (P = 0.0005), ascites (P = 0.001) and the overall impression of the operator (P = 0.0001). The diagnostic performances of these variables were low; sensitivity was < 58% and negative predictive value was < 73%. Therefore, dysfunction cannot be ruled out from Doppler-US.


The performance of Doppler-US for the detection of TIPS dysfunction is poor compared to angiography. New tools are needed to improve diagnosis of TIPS dysfunction.

Keywords: Transjugular intrahepatic portosystemic shunt, Dysfunction, Doppler-ultrasonography

Core tip: This large multicentric prospective study evaluates the performance of Doppler-ultrasonography (US) for the detection of transjugular intrahepatic portosystemic shunt dysfunction within a cohort of cirrhotic patients. Although many Doppler-US variables were significantly associated with dysfunction, the diagnostic performances of these variables were low compared to angiography.