Contrast enhanced ultrasound (CEUS) in the diagnosis of malignant liver lesions in patients with cirrhosis and transjugular intrahepatic portosystemic shunt (TIPS)

Backround:

Contrast enhanced ultrasound (CEUS) has been shown to distinguish between benign and malignant liver lesions. Transjugular intrahepatic portosystemic shunt (TIPS) can treat portal hypertensive complications but redirects portal venous perfusion from the liver. This suggests modified perfusion of liver nodules and therefore altered dynamics of contrast enhancement. Data on performance of CEUS in patients with TIPS is missing.

Aim:

The aim of this study was to evaluate the diagnostic performance of CEUS in the diagnosis of malignant liver lesions in patients with a transjugular intrahepatic portosystemic shunt.

Method:

This is a retrospective monocentric study. CEUS was used to identify malignant liver lesions. According to LI-RADS criteria, arterial phase hyperenhancement (APHE) of liver lesions is a risk factor for presence of HCC. Perfusion-index (PI) and resistance-index (RI) of hepatic artery and portal venous flow parameters were measured via doppler sonography. Diagnostic gold standard was MRT/CT or histology.

Results:

This study included 36 patients with liver cirrhosis and liver lesions (19 TIPS, 17 no TIPS). Median age was 60 years. 19 patients were male. Median MELD score was 13. PIi and RIi of hepatic artery showed no significant difference between patients with and without TIPS. Sensitivity to diagnose malignant lesions with CEUS in patients without TIPS was 100%, specifity was 83%, sensitivity and specificity in patients with TIPS was 87% and 78% respectively.

Conclusion:

CEUS is an appropriate tool to diagnose malignant liver lesions in patients with and without TIPS. However, diagnostic accuracy in patients with TIPS is slightly lower compared to patients without TIPS, requiring further investigations.