{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T17:05:22Z","timestamp":1776099922675,"version":"3.50.1"},"reference-count":46,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: In patients with liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) displays an effective method for treating portal hypertension. Main indications include refractory ascites and secondary prevention of esophageal bleeding. Color Doppler ultrasound (CDUS) plays a leading role in the follow-up management, whereas contrast-enhanced ultrasound (CEUS) is not routinely considered. We compared the efficacy of CEUS to CDUS and highlighted differences compared to findings of corresponding computed tomography (CT) and magnetic resonance imaging (MRI). (2) Methods: On a retrospective basis, 106 patients with CEUS examination after TIPS were included. The enrollment period was 12 years (between 2008 and 2020) and the age group ranged from 23.3 to 82.1 years. In addition, 92 CDUS, 43 CT and 58 MRI scans were evaluated for intermodal comparison. (3) Results: Intermodal analysis and comparison revealed a high level of concordance between CDUS, CT and MRI in the vast majority of cases. In comparison to CDUS, the correlation of the relevant findings was 92.5%, 95.3% for CT and 87.9% for MRI. In some cases, however, additional information was provided by CEUS (4) Conclusions: CEUS depicts a safe and effective imaging modality for follow-up after TIPS. In addition to CDUS, CEUS enables specific assessment of stent pathologies and stent dysfunction due to its capacity to dynamically visualize single microbubbles at high spatial and temporal resolution. Due to the low number of adverse events regarding the application of contrast agents, CEUS can be administered to a very broad patient population, thus avoiding additional radiation exposure compared to CT angiography in cases with divergent findings during follow-up.<\/jats:p>","DOI":"10.3390\/diagnostics11091593","type":"journal-article","created":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T10:02:11Z","timestamp":1630576931000},"page":"1593","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Diagnostic Value of Contrast-Enhanced Ultrasound for Evaluation of Transjugular Intrahepatic Portosystemic Shunt Perfusion"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2042-7322","authenticated-orcid":false,"given":"Constantin A.","family":"Marschner","sequence":"first","affiliation":[{"name":"Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Geyer","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias F.","family":"Froelich","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, 68167 Mannheim, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0832-5662","authenticated-orcid":false,"given":"Johannes","family":"R\u00fcbenthaler","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Schwarze","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3889-5447","authenticated-orcid":false,"given":"Dirk-Andr\u00e9","family":"Clevert","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1136\/gutjnl-2019-320221","article-title":"Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension","volume":"69","author":"Tripathi","year":"2020","journal-title":"Gut"},{"key":"ref_2","first-page":"267","article-title":"Creation of an intrahepatic portosystemic shunt with a Gr\u00fcntzig balloon catheter","volume":"126","author":"Colapinto","year":"1982","journal-title":"Can. Med. Assoc. J."},{"key":"ref_3","first-page":"701","article-title":"Transjugular Intrahepatic Portosystemic Shunt (TIPS): Pathophysiologic Basics, Actual Indications and Results with Review of the Literature","volume":"190","author":"Strunk","year":"2018","journal-title":"R\u00f6Fo"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s11739-019-02252-8","article-title":"Transjugular intrahepatic portosystemic shunt (TIPS): Current indications and strategies to improve the outcomes","volume":"15","author":"Vizzutti","year":"2020","journal-title":"Intern. Emerg. Med."},{"key":"ref_5","first-page":"1","article-title":"Transjugular Intrahepatic Portosystemic Shunt Placement for Portal Hypertension: Meta-Analysis of Safety and Efficacy of 8 mm vs. 10 mm Stents","volume":"2020","author":"Liu","year":"2020","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1055\/s-0034-1382790","article-title":"Transjugular Intrahepatic Portosystemic Shunt: Indications, Contraindications, and Patient Work-Up","volume":"31","author":"Kapoor","year":"2014","journal-title":"Semin. Interv. Radiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"346","DOI":"10.5152\/dir.2019.18416","article-title":"Long-term follow-up of transjugular intrahepatic portosystemic shunt (TIPS) with stent-graft","volume":"25","author":"Mur","year":"2019","journal-title":"Diagn. Interv. Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Chen, Y., Qiu, H., and Zhang, X. (2019). Transjugular intrahepatic portal shunt in the treatment of portal hypertension due to cirrhosis: Single center experience. BMC Surg., 19.","DOI":"10.1186\/s12893-019-0659-5"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e28689","DOI":"10.5812\/iranjradiol.28689","article-title":"Implantability, Complications, and Follow-Up After Transjugular Intrahepatic Portosystemic Stent-Shunt Creation with the 6F Self-Expanding Sinus-SuperFlex-Visual Stent","volume":"13","author":"Spira","year":"2016","journal-title":"Iran. J. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1055\/a-1330-9867","article-title":"Evaluation of impact of elective invasive examinations in patients with transjugular intrahepatic portosystemic shunt in the long-term follow up","volume":"59","author":"Seifert","year":"2021","journal-title":"Z. Gastroenterol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1007\/s00261-011-9763-4","article-title":"Contrast-enhanced ultrasound: A new method for TIPS follow-up","volume":"37","author":"Micol","year":"2011","journal-title":"Abdom. Imaging"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1016\/j.crad.2019.10.011","article-title":"Contrast-enhanced ultrasound at high mechanical index: A new method for transjugular intrahepatic portosystemic shunt follow-up","volume":"75","author":"Gao","year":"2020","journal-title":"Clin. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1007\/s001170050449","article-title":"CT-Angiographie zur nichtinvasiven Kontrolle der Offenheit des TIPSS","volume":"38","author":"Wunsch","year":"1998","journal-title":"Radiologe"},{"key":"ref_14","first-page":"224","article-title":"Der Stellenwert der Magnetresonanztomographie (MRT) f\u00fcr die Verlaufskontrolle bei Patienten mit transjugul\u00e4rem intrahepatischem portosystemischem Stent-Shunt (TIPSS)","volume":"174","author":"Schlegel","year":"2002","journal-title":"R\u00f6Fo"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1111\/j.1572-0241.2004.04056.x","article-title":"Polytetrafluoroethylene-Covered Stent Grafts for TIPS Procedure: 1-Year Patency and Clinical Results","volume":"99","author":"Angeloni","year":"2004","journal-title":"Am. J. Gastroenterol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.ejrad.2004.10.007","article-title":"Comparison of transjugular intrahepatic portosystemic shunt dysfunction in PTFE-covered stent-grafts versus bare stents","volume":"55","author":"Barrio","year":"2005","journal-title":"Eur. J. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Bucsics, T., Schoder, M., Diermayr, M., Feldner-Busztin, M., Goeschl, N., Bauer, D., Schwabl, P., Mandorfer, M., Angermayr, B., and Cejna, M. (2018). Transjugular intrahepatic portosystemic shunts (TIPS) for the prevention of variceal re-bleeding\u2014A two decades experience. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0189414"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1002\/hep.23383","article-title":"The role of transjugular intrahepatic portosystemic shunt (TIPS) in the management of portal hypertension: Update 2009","volume":"51","author":"Boyer","year":"2009","journal-title":"Hepatology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1007\/s00261-019-01981-w","article-title":"Performance of ultrasound for detection of transjugular intrahepatic portosystemic shunt dysfunction: A meta-analysis","volume":"44","author":"Manatsathit","year":"2019","journal-title":"Abdom. Radiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"29","DOI":"10.4103\/2156-7514.186510","article-title":"Transjugular Intrahepatic Portosystemic Shunt Dysfunction: Concordance of Clinical Findings, Doppler Ultrasound Examination, and Shunt Venography","volume":"6","author":"Owen","year":"2016","journal-title":"J. Clin. Imaging Sci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2696","DOI":"10.1111\/j.1572-0241.2005.00290.x","article-title":"Utility of Color Doppler Ultrasonography Predicting TIPS Dysfunction","volume":"100","author":"Gilabert","year":"2005","journal-title":"Am. J. Gastroenterol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.jus.2007.02.005","article-title":"Is color-Doppler US a reliable method in the follow-up of transjugular intrahepatic portosystemic shunt (TIPS)?","volume":"10","author":"Ricci","year":"2007","journal-title":"J. Ultrasound"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.4254\/wjh.v9.i27.1125","article-title":"Evaluation of Doppler-ultrasonography in the diagnosis of transjugular intrahepatic portosystemic shunt dysfunction: A prospective study","volume":"9","author":"Nicolas","year":"2017","journal-title":"World J. Hepatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1016\/j.cld.2014.07.006","article-title":"Transjugular Intrahepatic Portosystemic Shunt","volume":"18","author":"Patidar","year":"2014","journal-title":"Clin. Liver Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"5060","DOI":"10.3748\/wjg.v26.i34.5060","article-title":"Transjugular intrahepatic portosystemic shunt for Budd-Chiari syndrome: A comprehensive review","volume":"26","author":"Inchingolo","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.1097\/01.RVI.0000231951.47931.82","article-title":"Role of Ultrasound Surveillance of Transjugular Intrahepatic Portosystemic Shunts in the Covered Stent Era","volume":"17","author":"Carr","year":"2006","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"539","DOI":"10.1016\/j.jvs.2012.07.028","article-title":"Current status and future developments of contrast-enhanced ultrasound of carotid atherosclerosis","volume":"57","author":"Kate","year":"2013","journal-title":"J. Vasc. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.6061\/clinics\/2015(01)01","article-title":"Can contrast-enhanced ultrasound with second-generation contrast agents replace computed tomography angiography for distinguishing between occlusion and pseudo-occlusion of the internal carotid artery?","volume":"70","author":"Ventura","year":"2015","journal-title":"Clinics"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.ejvs.2007.12.008","article-title":"Assessment of Apparent Internal Carotid Occlusion on Ultrasound: Prospective Comparison of Contrast-enhanced Ultrasound, Magnetic Resonance Angiography and Digital Subtraction Angiography","volume":"35","author":"Hammond","year":"2008","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1055\/s-0028-1109811","article-title":"Detection and Characterization of Endoleaks Following Endovascular Treatment of Abdominal Aortic Aneurysms using Contrast Harmonic Imaging (CHI) with Quantitative Perfusion Analysis (TIC) Compared to CT Angiography (CTA)","volume":"31","author":"Jung","year":"2009","journal-title":"Ultraschall Med. Eur. J. Ultrasound"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1024\/0301-1526\/a000749","article-title":"Contrast-enhanced ultrasound of the abdominal aorta\u2014Current status and future perspectives","volume":"48","author":"Li","year":"2019","journal-title":"Vasa"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"S118","DOI":"10.21037\/cdt.2017.09.09","article-title":"Evolving clinical applications of contrast-enhanced ultrasound (CEUS) in the abdominal aorta","volume":"8","author":"Rafailidis","year":"2018","journal-title":"Cardiovasc. Diagn. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"19","DOI":"10.3233\/CH-2010-1283","article-title":"Comparison of time-resolved CT-angiography, contrast-enhanced ultrasound and digital subtraction angiography in a patient with a small type II endoleak after endovascular aneurysm repair","volume":"45","author":"Sommer","year":"2010","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"439","DOI":"10.7863\/jum.2009.28.4.439","article-title":"Sonazoid-enhanced ultrasonography for evaluation of the enhancement patterns of focal liver tumors in the late phase by intermittent imaging with a high mechanical index","volume":"28","author":"Luo","year":"2009","journal-title":"J. Ultrasound Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"94","DOI":"10.14366\/usg.19020","article-title":"A novel method to determine hepatic segments using Sonazoid, an ultrasound contrast agent","volume":"39","author":"Ham","year":"2020","journal-title":"Ultrasonography"},{"key":"ref_36","first-page":"1","article-title":"Defect Reperfusion Imaging with Sonazoid(R): A Breakthrough in Hepatocellular Carcinoma","volume":"5","author":"Salvatore","year":"2015","journal-title":"Liver Cancer"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1007\/s00535-009-0053-7","article-title":"Usefulness of Sonazoid contrast-enhanced ultrasonography for hepatocellular carcinoma: Comparison with pathological diagnosis and superparamagnetic iron oxide magnetic resonance images","volume":"44","author":"Korenaga","year":"2009","journal-title":"J. Gastroenterol."},{"key":"ref_38","first-page":"24","article-title":"Diagnostic value of sonazoid for hepatic metastasis: Comparison with FDG PET\/CT","volume":"57","author":"Hiraoka","year":"2011","journal-title":"Hepatogastroenterology"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"191","DOI":"10.14366\/usg.20057","article-title":"The AFSUMB Consensus Statements and Recommendations for the Clinical Practice of Contrast-Enhanced Ultrasound using Sonazoid","volume":"39","author":"Lee","year":"2020","journal-title":"Ultrasonography"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"784","DOI":"10.4103\/jcrt.jcrt_467_21","article-title":"Trans-jugular intrahepatic portosystemic shunt in patients with hepatic cellular carcinoma: A preliminary study","volume":"17","author":"Mao","year":"2021","journal-title":"J. Cancer Res. Ther."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"20682","DOI":"10.1038\/s41598-020-77801-9","article-title":"Alteration of contrast enhanced ultrasound (CEUS) of hepatocellular carcinoma in patients with cirrhosis and transjugular intrahepatic portosystemic shunt (TIPS)","volume":"10","author":"Chang","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00247-021-05010-1","article-title":"Transjugular intrahepatic portosystemic shunt creation may be associated with hyperplastic hepatic nodular lesions in the long term: An analysis of 18 pediatric and young adult patients","volume":"51","author":"Woerner","year":"2021","journal-title":"Pediatr. Radiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1369","DOI":"10.1016\/j.ultrasmedbio.2006.05.031","article-title":"The safety of Sonovue\u00ae in abdominal applications: Retrospective analysis of 23188 investigations","volume":"32","author":"Piscaglia","year":"2006","journal-title":"Ultrasound Med. Biol."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"R\u00fcbenthaler, J., \u010ce\u010datka, S., Froelich, M.F., Stechele, M., Marschner, C., Sabel, B.O., Bogner, F., Schnitzer, M.L., Overhoff, D., and Hokamp, N.G. (2020). Contrast-Enhanced Ultrasound (CEUS) for Follow-Up of Bosniak 2F Complex Renal Cystic Lesions\u2014A 12-Year Retrospective Study in a Specialized European Center. Cancers, 12.","DOI":"10.3390\/cancers12082170"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"65","DOI":"10.3233\/CH-199204","article-title":"Single-center study: The diagnostic performance of contrast-enhanced ultrasound (CEUS) for assessing focal splenic lesions compared to CT and MRI","volume":"73","author":"Schwarze","year":"2019","journal-title":"Clin. Hemorheol. Microcirc."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1658","DOI":"10.1016\/j.ejrad.2015.07.001","article-title":"EVAR: Benefits of CEUS for monitoring stent-graft status","volume":"84","author":"Cantisani","year":"2015","journal-title":"Eur. J. Radiol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/9\/1593\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:54:23Z","timestamp":1760165663000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/9\/1593"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,1]]},"references-count":46,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["diagnostics11091593"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11091593","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,1]]}}}