Changes of liver and spleen stiffness using Acoustic Radiation Force Impulse Imaging (ARFI) after TIPS implantation in patients with chronic liver disease

Problemstellung: The transjugular intrahepatic portosystemic shunt (TIPS) is the treatment of choice in patients with recurrent bleeding varices, refractory ascites and hepatorenal syndrome. The role of liver and spleen stiffness meaurement using ARFI elastography was not so far investigated. Patienten und Methode: A total of 36 patients (mean age 55 ± 15 y, 23 male) with indication for TIPS implantation were enrolled in this study. All patients received liver stiffness (LS) and spleen stiffness (SS) measurement before (Baseline), 2 days (Follow up 1) and 3 months (Follow up 2) after TIPS implantation. Portal pressure (PP), right atrial pressure (RAP) and hepatic vein pressure gradient (HVPG) were measured during TIPS implantation. Ergebnisse: At follow up 1, LS and SS showed significant decrease (LS: from 3.21 ± 0.7 m/s to 2.88 ± 0.7 m/s; p = 0.005; SS: from 3.55 ± 0.5 m/s to 3.22 ± 0.4 m/s; p = 0.001). Further significant decrease of LS and SS was detected between follow up 1 and 2 (LS: 2.79 ± 0.1 m/s p < 0.001; SS: 3.1 ± 0.4 m/s, p < 0.002). The mean decrease of HVPG was 12 ± 6 mmHg, PP was 6 ± 9 mmHg and RAP was 5 ± 5 mmHg after TIPS implantation. At follow up 1, the decrease of HVPG significantly correlated with the decrease of LS (r = 0.511, p = 0.015) and SS (r = 0.543, p = 0.009). Schlussfolgerungen: ARFI elastography of liver and spleen could be used in combination with Doppler/Duplex measurement for the assessment of TIPS success and function.