Quantitative analysis of in-TIPS thrombosis in abdominal CT

Simon Bernatz; Inga Weitkamp; Jan-Erik Scholtz; Vitali Koch; Leon D Grünewald; Christoph Mader; Jörg Ackermann; Moritz H Albrecht; Simon S Martin; Thomas J Vogl; Scherwin Mahmoudi

doi:10.1016/j.ejro.2022.100405

Quantitative analysis of in-TIPS thrombosis in abdominal CT

Eur J Radiol Open. 2022 Feb 23:9:100405. doi: 10.1016/j.ejro.2022.100405. eCollection 2022.

Affiliations

¹ Department of Diagnostic and Interventional Radiology, Institute for Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
² Department of Molecular Bioinformatics, Institute of Computer Science, Johann Wolfgang Goethe-University, 60325, Frankfurt am Main, Germany.

Abstract

Purpose: To identify transjugular intrahepatic portosystemic shunt (TIPS) thrombosis in abdominal CT scans applying quantitative image analysis.

Materials and methods: We retrospectively screened 184 patients to include 20 patients (male, 8; female, 12; mean age, 60.7 ± 8.87 years) with (case, n = 10) and without (control, n = 10) in-TIPS thrombosis who underwent clinically indicated contrast-enhanced and unenhanced abdominal CT followed by conventional TIPS-angiography between 08/2014 and 06/2020. First, images were scored visually. Second, region of interest (ROI) based quantitative measurements of CT attenuation were performed in the inferior vena cava (IVC), portal vein and in four TIPS locations. Minimum, maximum and average Hounsfield unit (HU) values were used as absolute and relative quantitative features. We analyzed the features with univariate testing.

Results: Subjective scores identified in-TIPS thrombosis in contrast-enhanced scans with an accuracy of 0.667 - 0.833. Patients with in-TIPS thrombosis had significantly lower average (p < 0.001), minimum (p < 0.001) and maximum HU (p = 0.043) in contrast-enhanced images. The in-TIPS / IVC ratio in contrast-enhanced images was significantly lower in patients with in-TIPS thrombosis (p < 0.001). No significant differences were found for unenhanced images. Analyzing the visually most suspicious ROI with consecutive calculation of its ratio to the IVC, all patients with a ratio < 1 suffered from in-TIPS thrombosis (p < 0.001, sensitivity and specificity = 100%).

Conclusion: Quantitative analysis of abdominal CT scans facilitates the stratification of in-TIPS thrombosis. In contrast-enhanced scans, an in-TIPS / IVC ratio < 1 could non-invasively stratify all patients with in-TIPS thrombosis.

Keywords: Angiography; CT; CT, Computed tomography; HU, Hounsfield units; IVC, Inferior vena cava; In-TIPS thrombosis; PV, Portal vein; Quantitative Imaging; ROI, Region of interest; TIPS; TIPS, Transjugular intrahepatic portosystemic shunt; Transjugular Intrahepatic Portosystemic Shunt; YE, Years of experience.