Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Japanese Journal of Radiology
Published in: Japanese Journal of Radiology 7/2017

01-07-2017 | Original Article

Changes in liver perfusion and function before and after percutaneous occlusion of spontaneous portosystemic shunt

Authors: Yasukazu Kako, Koichiro Yamakado, Wataru Jomoto, Toshiya Nasada, Koichiro Asada, Haruyuki Takaki, Kaoru Kobayashi, Takashi Daimon, Shozo Hirota

Published in: Japanese Journal of Radiology | Issue 7/2017

Login to get access

Abstract

Purpose

To evaluate changes in liver perfusion after occlusion of spontaneous portosystemic shunt and to analyze mechanisms of liver profile improvement.

Materials and methods

Liver function changes and portal venous and hepatic arterial blood flow were evaluated using perfusion CT before and after shunt occlusion in 23 patients who underwent percutaneous occlusion of spontaneous portosystemic shunt because of gastric varices (n = 15) or hepatic encephalopathy (n = 8).

Results

Portal venous blood flow was significantly higher at 1 week (278.7 ml/min, 92.7–636.7, p = 0.012), 1 month (290.0 ml/min, 110.1–560.1, p < 0.001) and 3 months (299.6 ml/min, 156.7–618.5, p = 0.033) after shunt occlusion than the baseline (220.9 ml/min, 49.5–566.7). Hepatic arterial liver blood flow became lower than the baseline (132.3 ml/min, 47.9–622.3) after shunt occlusion, but a significant decrease was observed only at 1 month later (107.9 ml/min, 45.8–263.6 p = 0.027). Serum albumin concentration became significantly higher than the baseline (3.4 mg/dl, 1.9–4.5) at 1 month (3.8 mg/dl, 2.3–4.3, p = 0.018) and 3 months (3.9 mg/dl, 2.6–4.3, p = 0.024) after shunt occlusion.

Conclusion

Shunt occlusion increases portal venous blood flow and decreases hepatic arterial blood flow, thereby improving the liver profile.
Literature
1.
The rules for study of portal hypertension. The Japan Society for Portal Hypertension. 3rd ed. Ltd: The Kanehara & Co.; 2013.
2.
Hirota S, Matsumoto S, Tomita M, Sako M, Kono M. Retrograde transvenous obliteration of gastric varices. Radiology. 1999;211(2):349–56.CrossRefPubMed
3.
Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded reterograde transvenous obliteration. J Gastroenterol Hepatol. 1996;11(1):51–8.CrossRefPubMed
4.
Ninoi T, Nakamura K, Kaminou T, Nishida N, Sakai Y, Kitayama T, et al. TIPS versus transcatheter sclerotherapy for gastric varices. Am J Roentgenol. 2004;183:369–76.CrossRef
5.
Park JK, Saab S, Kee ST, Busuttil RW, Kim HJ, Durazo F, et al. Balloon-occluded retrograde transvenous obliteration (BRTO) for treatment of gastric varices: review and meta-analysis. Dig Dis Sci. 2015;60:1543–53.CrossRefPubMed
6.
Katoh K, Sone M, Hirose A, Inoue Y, Fujino Y, Onodera M, et al. Balloon-occluded retrograde transvenous obliteration for gastric varices: the relationship between clinical outcome and gastrorenal shunt occlusion. BMC Med Imaging. 2010;10:2.CrossRefPubMedPubMedCentral
7.
Cho SK, Shin SW, Lee IH,DO YS, Choo SW, Park KB et al. Balloon-occluded retrograde transvenous obliteration for gastric varices: outcome and complication in 49 patients. Am J Roentgenol. 2007;189:W365–W72.
8.
Uehara H, Akahoshi T, Tomikawa M, Kinjo N, Hashimoto N, Nagao Y, et al. Prediction of improved liver function after balloon-occluded retrograde transvenous obliteration: relation to hepatic vein pressure gradient. J Gastroenterol Hepatol. 2012;27:137–41.CrossRefPubMed
9.
Akahane T, Iwasaki T, Kobayashi N, Tanabe N, Takahashi N, Gama H, et al. Changes in liver function parameters after occlusion of gastrorenal shunts with balloon-occluded retrograde transvenous obliteration. Am J Gastroenterol. 1997;92:1026–30.PubMed
10.
Chikamori F, Kuniyoshi N, Shibuya S, Takase Y. Short-term hemodynamic effects of transjugular retrograde obliteration of gastric varices with gastrorenal shunt. Dig Surg. 2000;17(4):332–6.CrossRefPubMed
11.
Fukuda T, Hirota S, Sugimura K. Long-term results of balloon-occluded retrograde transvenous obliteration fort the treatment of gastric varices and hepatic encephalopathy. J Vasc Interv Radiol. 2001;12(3):327–36.CrossRefPubMed
12.
Phelps ME, Kuhi DE. Pitfalls In the measurement of cerebral blood volume with computed tomography. Radiology. 1976;121:375–7.CrossRefPubMed
13.
Axel L. Cerebral blood flow determination by rapid-sequence computed tomography. Radiology. 1980;137:679–86.CrossRefPubMed
14.
Katada Y, Shukuya T, Kawashima M, Nozaki M, Imai H, Natori T, et al. A comparative study between arterial spin labeling and CT perfusion methods on hepatic portal venous flow. Jpn J Radiol. 2012;30:863–9.CrossRefPubMed
15.
Takahashi H, Shigefuku R, Yoshida Y, Ikeda H, Matsunaga K, Matsumoto N, et al. Correlation between hepatic blood flow and liver function in alcoholic liver cirrhosis. World J Gastroenterol. 2014;20(45):17065–74.CrossRefPubMedPubMedCentral
16.
Miles K, Dawson P, Blomley M. Functional computed tomography. Isis Medical Media: Oxford, England; 1997. p. 77–82.
17.
Miles KA. Measurement of tissue perfusion by dynamic computed tomography. Br J Radiol. 1991;64:409–12.CrossRefPubMed
18.
Miles KA, Hayball MP, Dixon AK. Functional images of hepatic perfusion obtained with dynamic CT. Radiology. 1993;188:405–11.CrossRefPubMed
19.
20.
Takahashi H, Suzuki M, Ikeda H, Kobayashi M, Sase S, Yotsuyanagi H, et al. Evaluation of quantitative portal venous, hepatic arterial, and total hepatic tissue blood flow using xenon CT in alcoholic liver cirrhosis-comparison with liver cirrhosis related to Hepatic C virus and nonalcoholic steatohepatitis. Alcohol Clin Exp Res. 2010;34:S7–13.CrossRefPubMed
21.
Richter S, Mucke I, Menger MD, Vollmar B. Impact of intrinsic blood flow regulation in cirrhosis: maintenance of hepatic arterial buffer response. Am J Physiol Gastrointest Liver Physiol. 2000;279:G454–62.PubMed
22.
Lautt WW. Mechanism and role of intrinsic regulation of hepatic arterial blood flow: hepatic arterial buffer response. Am J Physiol. 1985;249:G549–56.PubMed
23.
Lautt WW. The 1995 Ciba-Geigy award lecture. Intrinsic regulation of hepatic blood flow. Can J Physiol Pharmacol. 1996;74:223–33.CrossRefPubMed
24.
Kasuga A, Mizumoto H, Matsutani S, Kobayashi A, Endo T, Ando T, et al. Portal hemodynamics and clinical outcomes of patients with gastric varices after balloon-occluded retrograde transvenous obliteration. J Hepatobiliary Pancreat Sci. 2010;17:898–903.CrossRefPubMed
25.
Miyamoto Y, Oho K, Kumamoto M, Toyonaga A, Sata M. Balloon-occluded retrograde transvenous obliteration improves liver function in patients with cirrhosis and portal hypertension. J Gastroenterol Hepatol. 2003;18:934–42.CrossRefPubMed
26.
Takahashi H, Suzuki M, Shigefuku R, Okano M, Hiraishi T, Takagi R, et al. Xenon computed tomography can evaluate the improvement of hepatic hemodynamics before and after endoscopic injection sclerotherapy. J Gastroenterol. 2013;48:1353–61.CrossRefPubMed
27.
Saad WE, Bleibel W, Adenaw N, Wagner CE, Anderson C, Angle JF. Thrombocytopenia in patients with gastric varices and the effect of balloon-occluded retrograde transvenous obliteration on the platelet count. J Clin Imaging Sci. 2014;30(4):24.CrossRef
28.
Yamagami T, Kato T, Iida S, Tanaka O, Nishimura T. Change in the hemodynamics of the portal venous system after retrograde transvenous balloon occlusion of a gastrorenal shunt. AJR Am J Roentgenol. 2003;181:1011–5.CrossRefPubMed
Metadata
Title
Changes in liver perfusion and function before and after percutaneous occlusion of spontaneous portosystemic shunt
Authors
Yasukazu Kako
Koichiro Yamakado
Wataru Jomoto
Toshiya Nasada
Koichiro Asada
Haruyuki Takaki
Kaoru Kobayashi
Takashi Daimon
Shozo Hirota
Publication date
01-07-2017
Publisher
Springer Japan
Published in
Japanese Journal of Radiology / Issue 7/2017
Print ISSN: 1867-1071
Electronic ISSN: 1867-108X
DOI
https://doi.org/10.1007/s11604-017-0647-6

Other articles of this Issue 7/2017

Japanese Journal of Radiology 7/2017 Go to the issue

Original Article

The value of initial sonography compared to supplementary CT for diagnosing right-sided colonic diverticulitis

Original Article

Uncertainty of cosmetic evaluation after accelerated partial breast irradiation: interim analysis of a Japanese prospective multi-institutional feasibility study

Letter to the Editor

Utility of MR imaging in the evaluation of colon cancer

Pictorial Essay

Neuroimaging findings of postnatally acquired Zika virus infection: a pictorial essay

Technical Note

SUV navigator enables rapid [18F]-FDG PET/CT image interpretation compared with 2D ROI and 3D VOI evaluations

Original Article

Thin-section CT findings of thoracolithiasis