Contrast-enhanced sonography of vesicoureterorenal reflux in children: preliminary results.

OBJECTIVE: The aim of our study was to evaluate contrast-enhanced sonography as an alternative to radiographic voiding cystourethrography in the detection of vesicoureteral reflux. SUBJECTS AND METHODS: A total of 46 children, ranging in age from 3 weeks to 14 years (median: 4 years, 6 months) with 92 ureterorenal units were investigated for reflux using radiographic voiding cystourethrography and contrast-enhanced sonography in one session. After sonography of the urinary tract, the bladder was filled with saline solution via a catheter. Later, a contrast-enhancing agent was instilled and sonography was repeated. Documentation was done using S-VHS video and a laser camera. Reflux was diagnosed when microbubbles were observed in the ureter or in the renal pelvis. In addition, conventional voiding cystourethrography was performed. Patients without micturition during either sonography or radiographic examination were excluded (eight ureterorenal units). RESULTS: The findings obtained by contrast-enhanced sonography and voiding cystourethrography were concordant in 78 ureterorenal units (92.9%). No reflux was detected in 67 units (79.8%) by either method. With voiding cystourethrography as the standard of reference, the sensitivity of contrast-enhanced sonography was 91.7%; the specificity, 93.1%; and the accuracy, 92.9%. The positive predictive value was 68.8%, and the negative predictive value was 98.5%. CONCLUSION: Contrast-enhanced sonography is highly sensitive for the detection of vesicoureteral reflux. Therefore, it may reduce the number of radiographic investigations.     

Doppler sonography of the anterior ascending cervical arteries of the hip: evaluation of healthy and painful hips in children

OBJECTIVE: We evaluated the Doppler sonography of small feeding arteries to the femoral head in children. SUBJECTS AND METHODS: In a prospective study of 224 hips in 112 patients (mean age, 5 years 11 months), the anterior ascending cervical arteries of the hip were identified with color Doppler sonography. Subsequently, we measured the resistive index (RI) with pulsed Doppler sonography. RESULTS: In 61% (137/224) of hips, a Doppler signal could be obtained. In asymptomatic hips (n = 64), the mean RI was 0.58. In symptomatic hips, the definitive diagnoses and mean values of RI included transient synovitis (n = 31) and 0.92, Perthes' disease (n = 9) and 0.67, and miscellaneous (n = 5) and 0.68. In 28 symptomatic hips, no definite diagnosis could be determined and the complaints spontaneously disappeared during follow-up (mean RI, 0.57). We found no statistically significant difference in the RI of symptomatic versus asymptomatic hips, except in patients with transient synovitis (p < 0.001). In 11 hips with transient synovitis that were reexamined after 4-6 weeks, the RI returned to normal (0.57). The RI in symptomatic hips showed a positive correlation with the amount of effusion (r = 0.69, p < 0.001). In symptomatic and asymptomatic hips, we found no correlation with age (p = 0.9 and 0.1, respectively). CONCLUSION: The deep capsular vessels of the hip joint can be evaluated on Doppler sonography in more than 60% of hips. Also, the RI is age independent and correlates with the amount of effusion.     

Early postoperative hepatic sonography as a predictor of vascular and biliary complications in adult orthotopic liver transplant patients

OBJECTIVE: Our objective was to quantitatively assess the value of early posttransplantation hepatic artery resistive indexes in predicting vascular and nonvascular complications in adult orthotopic liver transplant (OLT) patients. MATERIALS AND METHODS: Between 1999 and 2001, 110 consecutive adults received grafts. Doppler sonographic graft evaluations measured main, right, and left resistive indexes within 24 to 48 hr after surgery (normal resistive index cutoff, 0.6). Clinical, operative, procedural, and radiologic reports were reviewed for vascular and biliary complications. Frequency, Student's t test, logistic, and regression statistical analyses were performed. RESULTS: even patients (6.4%) had vascular complications, including two (1.8%) hepatic artery and two (1.8%) hepatic vein stenoses, one (0.9%) hepatic vein thrombosis, two (1.8%) portal vein thromboses, and one (0.9%) thrombosis and two (1.8%) stenoses of the inferior vena cava (IVC). In 19 patients (17.3%), biliary complications included anastomotic strictures and leaks 1 week to 18 months after transplantation. In 11 patients (10%), sonographically large hematomas required surgical evacuation. In grafts with vascular complications or large hematomas, the mean early posttransplant main, right, and left indexes were significantly lower (< or = 0.6) than without these complications (p < 0.01). In grafts with and without biliary complications, mean early posttransplant main, right, and left indexes did not differ significantly. CONCLUSION: In adult OLT patients, low early posttransplant hepatic artery resistive indexes were sensitive (100%) and specific (80%) predictors for vascular complications (e.g., hepatic artery, portal vein, hepatic vein, and IVC) but not for biliary complications. All patients with indexes less than 0.6 within 24-48 hr after surgery should be monitored closely for vascular complications.     

早期口服糖皮质激素对成人分泌性中耳炎中耳积液的影响

目的探讨在病程早期口服糖皮质激素对成人分泌性中耳炎(OME)中耳积液的影响。方法选择46例病程在2周之内的成人OME患者为研究对象,采用前瞻性随机对照研究,试验组在鼓膜穿刺抽液、口服克拉霉素及盐酸氨溴索基础上口服地塞米松治疗,对照组不使用地塞米松。随访观察6个月。结果在药物疗程内,试验组和对照组中耳积液复发率分别为30.4%和60.9%,有统计学差异(P<0.05);试验组和对照组积液复发的平均间隔时间分别为(9.6±3.0)d和(5.6±3.3)d,有统计学差异(P<0.05)。在6个月随访期内,试验组和对照组积液复发率分别为18.8%和22.2%,无统计学差异(P>0.05);试验组和对照组痊愈率分别为78.3%和69.6%,无统计学差异(P>0.05)。结论在OME病程早期,口服糖皮质激素对中耳积液有短期抑制作用,能改善患者的临床症状,但其远期疗效有限,使用与否并不能影响疾病的最终转归。     

The widened teardrop distance: a plain film indicator of hip joint effusion in adults

The teardrop distance is defined as the distance from the lateral margin of the pelvic teardrop to the most medial aspect of the femoral head as seen on anteroposterior pelvic radiographs. The structure responsible for the teardrop is the anteroinferior portion of the acetabular fossa with contributions from the ischium and from the superior pubic ramus. Anteroposterior pelvic radiographs of 10 patients with documented cases of unilateral hip effusion were retrospectively evaluated for teardrop distance widening on the affected side. Proof of the presence of hip effusion was based on the results of percutaneous hip joint aspirations as described in the patient's medical records. A teardrop distance widening of 1 mm or more was always consistent with hip joint fluid. In addition, radiographs from 20 patients with no known hip abnormalities were reviewed as a control population. These showed side-to-side symmetry in 16 cases (80%) and widening of less than 1 mm in the remaining four cases (20%). Thus, hip joint effusion in adults can be accurately diagnosed from plain radiographs in the presence of a teardrop asymmetry of 1 mm or more and in the absence of degenerative joint disease.     

Assessment of muscle function in patients with COPD: preliminary results

Aim. – To investigate muscle function during brief maximal sprint exercise in patients with chronic obstructive pulmonary disease (COPD).Materials and methods. – Eight patients underwent three tests: three maximal sprints on a specialised cycle ergometer to assess individual velocity–power relationship, anthropometric measurement, maximal oxygen uptake (VO₂max).Results. – The maximal anaerobic power and corresponding optimal velocity were 3.9 ± 1.6 W kg^–1 and 85.4 ± 17.0 rpm, respectively. COPD patients showed a 30% decrease in maximal anaerobic power, compared to healthy older subjects (5.6 ± 1.1 W kg^–1). No such difference was observed in terms of optimal velocity. In addition, COPD patients showed a 43% lower VO₂max compared to healthy older subjects (Eur. J. Appl. Physiol. 77 (1998) 182; Eur. J. Appl. Physiol. 76 (1997) 81).Conclusion. – The decrease in maximal anaerobic power was less than the decrease in maximal aerobic power.     

Imaging of adult astrocytic brain tumours with 7 T MRI: preliminary results

Purpose

In this study tumour vascularity and necrosis of intracranial astrocytomas were compared using 7 T and 1.5 T magnetic resonance imaging (MRI).

Methods

Fifteen patients with histologically proven astrocytomas (WHO grades II–IV) were prospectively examined at 1.5 T (Magnetom Espree or Sonata) and 7 T (Magnetom 7 T, Siemens, Erlangen, Germany) with T2*-w (weighted), T1-w with (only a subset of five patients at 7 T) and without contrast medium, T2-w and proton-density (PD)-w MRI. Clinically used 1.5 T sequences were adapted to 7 T. Histological findings and T2*-w MR images at both field strengths were compared for the presence of assumed tumour microvascularity and necrosis. Two diffusely infiltrating astrocytomas, four anaplastic astrocytomas and nine glioblastomas were included.

Results

T2*-w images depicted susceptibility patterns representing presumed tumour microvascularity in 8 out of 15 (53%) gliomas at 7 T compared with 5 out of 15 (33%) gliomas at 1.5 T. Compared with 1.5 T MRI three additional necrotic tumour areas were depicted only on 7 T T2- and T2*-w images of one glioblastoma. On T1-w MR images, contrast enhancement of five out of five glioblastomas was similar at both field strengths.

Conclusion

7 T gradient-echo sequences provide excellent image contrast of presumed microvasculature and necrosis in astrocytomas.     

Effects of joint effusion on quadriceps muscles in patients with knee osteoarthritis

ObjectivesTo evaluate the effect of knee effusion on the quadriceps muscle in patients with knee osteoarthritis (OA).DesignSingle-blind, randomized, controlled clinical trial.SettingSingle medical center.ParticipantsForty subjects with knee OA were assigned to a experimental (n = 20) or control (n = 20) group.Main outcome measuresQuadriceps torque and root mean square (RMS) values of surface electromyography (EMG) of the vastus medialis and vastus lateralis muscles were measured during a maximal isometric contraction at 60° knee flexion. Thereafter, 20 mL of normal saline was injected into the knee joint of the experimental group. Quadriceps torque and RMS values were again measured.ResultsFive subjects did not complete the study. No significant difference in quadriceps peak torque or RMS of EMG activity was observed at baseline, pre-effusion, or post-effusion measures in either group. The experimental group showed no significant change in quadriceps peak torque or RMS of EMG activity in any period compared with the control group.ConclusionsThese results demonstrate that a 20 ml joint effusion did not affect peak torque or RMS values of the quadriceps muscle in patients with knee OA.     

Bone marrow immunoscintigraphy in haematological patients with pancytopenia: preliminary results

The aim of this study was to assess the clinical value of bone marrow immunoscintigraphy using the (99m)Tc labelled anti-NCA-95 antigranulocyte antibodies (AGAb) and of AGAb bone marrow uptake ratio (UR) in the initial diagnostic work-up of diseases with depression of the bone marrow. Twenty-four whole-body bone marrow scans were performed in 23 patients (11 women, 12 men; median age 46 years, range 17-74 years) 5 h after i.v. injection of 370 MBq of AGAb. The UR was calculated from the posterior view drawing an irregular region of interest around the sacroiliac and a background areas. The mean UR in pancytopenic patients was 2.3+/-1.5 (range 0.3-5.8), thus being significantly lower (P=0.45 x 10(-6)) than the mean UR in a control group of 50 patients (mean UR 7.3+/-2.3; range 4.4-12.6) obtained previously. Considering patient age, there was no overlap between UR of pancytopenic patients and the respective normal ranges. The bone marrow appearance on scans seemed to be characteristic for the different haematological diseases investigated. In six patients with myelofibrosis, bone marrow scans demonstrated diffusely decreased bone marrow activity and prominent splenic uptake, possibly related to extramedullary haematopoiesis. In aplastic anaemia, highly reduced and patchy marrow uptake was observed in four patients (five scans), in one of them persisting even after blood cell counts had recovered to the near-normal range. In another two patients with aplastic anaemia, diffusely decreased bone marrow uptake was obtained. In patients with myeloid leukaemia, bone marrow patterns were almost normal probably because the target antigen is often expressed on neoplastic myeloid cells, too. Bone marrow extension was a common finding in these patients. There is an obvious differentiation between haematological patients with pancytopenia and normal subjects by means of AGAb bone marrow uptake ratio. The distinct patterns of AGAb distribution may be indicative for particular haematological diseases.     

Lumbar facet joint injection in low back pain and sciatica: preliminary results

Fluoroscopically controlled intra-articular facet joint block is a reliable method of diagnosing low back pain and sciatica caused by lumbar facet arthropathy. Of 20 patients studied, 13 had complete and immediate relief of pain, confirming the diagnosis, Six patients have been free of pain for more than six months following a single facet joint block with injection of a local anesthetic and corticosteroid suspension. Preliminary findings suggest that computed tomography has an important role in diagnosing symptomatic facet arthropathy.     

Intraoperative sonography of cervical spinal cord injury: results in 30 patients

Intraoperative spinal sonography (IOSS) with a 7.5-MHz sector transducer was performed in 30 patients with cervical spine injury associated with neurologic deficits. A laminectomy (25 patients) or anterior corpectomy (five patients) during spinal surgery provided the IOSS imaging window. The surgery was performed for either spinal decompression or fixation as part of the initial care of these patients and occurred 1 to 39 days (mean, 12.4 days) after injury. Parenchymal spinal cord lesions at the level of cervical fracture or stenosis that were compatible with the initial neurologic deficits were detected by IOSS in 28 (96.5%) of 29 patients with technically adequate studies. Lesions appeared as foci of increased echogenicity and were sorted into five injury grades (0 through IV). The IOSS injury grade in each patient was determined by the maximal diameter of regions of increased echogenicity and/or cyst formation in either the sagittal or transverse image plane. The extent of initial neurologic injury and its recovery was assessed by using the ASIA motor score (0 to 100 unit scale) at admission and during follow-up. The IOSS injury grade was correlated with the initial ASIA motor score (p less than 0.009, Spearman's Rank Order Test), indicating that the IOSS echogenicity is related to the extent of initial clinical motor deficit. Regression analysis disclosed that both the IOSS injury grade and the initial ASIA score were correlated with the follow-up ASIA score (p less than 0.05 and p less than 0.001, respectively). However, the addition of the IOSS injury grade to the initial ASIA motor score did not improve the predictive ability of the follow-up ASIA motor score.(ABSTRACT TRUNCATED AT 250 WORDS)     

Power Doppler sonography with and without echo-enhancing contrast agent and contrast-enhanced MRI for the evaluation of rheumatoid arthritis of the shoulder joint: differentiation between synovitis and joint effusion

OBJECTIVE: To evaluate patients with clinically active rheumatoid arthritis (RA) of the shoulder for joint effusion and synovitis using conventional sonography, power Doppler (PD) sonography with and without echo-enhancing contrast agent, and contrast-enhanced MRI. DESIGN AND PATIENTS: Twenty-four patients (mean age 64 years) with known RA had one symptomatic shoulder evaluated by conventional gray-scale sonography and PD sonography before and after intravenous administration of the echo-enhancing contrast agent Levovist (300 mg/ml, 2.5 g). The degree and extent of the altered echo pattern in the subacromial bursa, axillary recess and glenohumeral joint seen by conventional gray-scale sonography and the intensity of vascular signals of PD sonography were compared with the findings of MRI obtained with T2-weighted turbo spin-echo sequences and contrast-enhanced T1-weighted fat-saturated spin-echo sequences. MRI was evaluated by two readers in consensus without knowledge of the sonographic findings. RESULTS: MRI, which was used as the reference examination, detected joint effusion in 71% (17/24) and synovitis in 92% (22/24) of the patients. Conventional sonography revealed an abnormal articular echo pattern in 96% (23/24) of the patients, especially in the axillary recess and subacromial bursa, but failed to attribute the altered echo pattern to either fluid or specific synovitis. PD sonography allowed a specific diagnosis of synovitis in 33% (8 patients), which increased to 50% (12 patients) after administration of an echo-enhancing contrast agent. In 42% (10/24) of the patients, the findings of synovitis demonstrated by MRI corresponded to an altered echo pattern by conventional sonography, but vascular signals were absent by PD sonography with or without echo-enhancing contrast agent. CONCLUSIONS: Using MRI as the "gold standard," PD sonography with and without echo-enhancing contrast agent cannot reliably identify synovitis or distinguish synovial inflammation from effusion in the shoulder joint.     

Morphological analysis of the knee joint in patients with hip dysplasia

Purpose

The purpose of this study was to investigate the morphological changes of the knee in patients with untreated developmental dysplasia of the hip.

Methods

Morphological analysis of 150 knee joints in 75 patients with developmental dysplasia of the hip was performed by examining computed tomographic (CT) images. Of these patients, 36 had unilateral developmental dysplasia of the hip and 39 had bilateral developmental dysplasia of the hip. Therefore, 36 hips were normal, and 114 hips were dislocated. CT images ranged from the iliac crest to 2 cm inferior to the tibial tuberosity.

Results

Compared with the knees in patients with normal hips, the femoral condyles in patients with dislocated hips were smaller and exhibited greater medial and lateral condylar asymmetry. The anterior femoral condylar angle of the femur was increased, as was the groove angle, while the trochlear groove was shallower in patients with dislocated hips. Furthermore, the lateral patella shift was reduced and the patellar tilt angle was increased in patients with dislocated hips compared with patients with normal hips. The extent of changes in these variables differed with the degree of dislocation. However, the posterior condylar angle of the femur was not affected by the degree of dislocation.

Conclusion

These findings suggest that developmental dysplasia of the hip is associated with morphological changes in the knee joint. These changes should be considered during hip and knee surgery.

Level of evidence

Prospective study, Level II.     

Intraoperative sonography of cervical spinal cord injury: results in 30 patients

Intraoperative spinal sonography (IOSS) with a 7.5-MHz sector transducer was performed in 30 patients with cervical spine injury associated with neurologic deficits. A laminectomy (25 patients) or anterior corpectomy (five patients) during spinal surgery provided the IOSS imaging window. The surgery was performed for either spinal decompression or fixation as part of the initial care of these patients and occurred 1 to 39 days (mean, 12.4 days) after injury. Parenchymal spinal cord lesions at the level of cervical fracture or stenosis that were compatible with the initial neurologic deficits were detected by IOSS in 28 (96.5%) of 29 patients with technically adequate studies. Lesions appeared as foci of increased echogenicity and were sorted into five injury grades (0 through IV). The IOSS injury grade in each patient was determined by the maximal diameter of regions of increased echogenicity and/or cyst formation in either the sagittal or transverse image plane. The extent of initial neurologic injury and its recovery was assessed by using the ASIA motor score (0 to 100 unit scale) at admission and during follow-up. The IOSS injury grade was correlated with the initial ASIA motor score (p less than 0.009, Spearman's Rank Order Test), indicating that the IOSS echogenicity is related to the extent of initial clinical motor deficit. Regression analysis disclosed that both the IOSS injury grade and the initial ASIA score were correlated with the follow-up ASIA score (p less than 0.05 and p less than 0.001, respectively). However, the the addition of IOSS injury grade to the initial ASIA motor score did not improve the predictive ability of the follow-up ASIA motor score. This was interpreted as indicating that the IOSS injury grade and initial ASIA motor score contain similar information about the extent of the traumatic spinal cord injury. IOSS was compared with concurrently performed cervical spine MR images in 12 patients. IOSS confirmed parenchymal lesions demonstrated by MR (five patients), revealed cord lesions not detected by suboptimal MR studies (three patients), and better characterized lesions with early cyst formation (two patients). IOSS did not detect possibly significant herniated intervertebral disks in two patients because of its limited field of view.     

高龄髋部骨折术后认知功能障碍的特点及防治康复措施

 目的 探讨高龄髋部骨折患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)的特点及防治康复措施。方法 回顾性分析2011-01至2014-01收治的70岁以上髋部骨折手术患者120例的临床资料,其中术后出现POCD患者40例, 探讨其临床特点、发生原因及防治措施。结果 经对症处理及综合治疗后,25 例术后 1 周内认知功能障碍好转,13 例术后 2 周内好转,2 例术后随访6个月仍有认知功能障碍。高龄髋部骨折POCD发病与术前认知障碍、围术期贫血、术中出血量及手术时间相关。结论 认识到POCD不是单一因素造成的,也不是多种因素的简单相加,而是病因与疾病之间,甚至病因与病因之间的相互联系、相互作用的结果。     

Lower-extremity venous thrombosis in patients with acute hip fractures: determination of anatomic location and time of onset with compression sonography

Patients with acute hip fractures are at increased risk for the development of lower-extremity deep venous thrombosis and its major complication, pulmonary embolism. It is furthermore recognized that the risk of clinically important pulmonary embolism depends to some degree on the anatomic location of the preexisting thrombosis. Because of the increased risk of thromboembolic disease, most patients with hip fracture are treated with one of several prophylactic regimens. The potential for effective prophylaxis may depend on the time of onset of the venous thrombosis. We used compression sonography to determine the anatomic location and time of onset of deep venous thrombosis in patients with hip fractures being treated with antithrombotic prophylaxis. Ninety-six patients had compression sonography of the injured extremity perioperatively and serially until discharge. Ninety-three also were examined with contrast venography when the sonogram suggested thrombus or at discharge if all sonograms were normal. Twenty areas of thrombus were identified in 18 patients, thereby yielding a prevalence of thrombosis of 19%. All patients were asymptomatic. Above-knee clot was diagnosed in 14 (78%) of these 18 patients. Nine (64%) of the 14 patients with significant clot had the abnormality on their first perioperative investigation (in eight of nine cases, the clot was adjacent to the fracture site), before any means of prophylaxis could have been initiated. Significant thrombosis developed in six patients later in their course (in only one case was the clot related to the fracture site), and the thrombus was an extension of below-knee clot in the minority of the patients. We conclude that although currently acceptable prophylaxis may decrease the frequency of thrombosis, it does little to prevent above-knee clot, which often antedates the initiation of therapy. Furthermore, as the clinical diagnosis of deep venous thrombosis is difficult in patients with acute hip fracture, serial compression sonograms are recommended so that patients with unsuspected clot may be treated with appropriate anticoagulation and/or caval interruption.     

盐酸右美托咪定对老年髋部骨折患者术后谵妄的影响

 目的 探讨盐酸右美托咪定对老年髋部骨折患者术后谵妄的影响。方法 选择在腰硬联合麻醉下择期行股骨粗隆间骨折髓内钉固定术81例,股骨颈骨折闭合复位内固定术55例,随机将患者分为盐酸右美托咪定组(69例)和对照组(67例),前者入ICU后20 min内给予盐酸右美托咪定持续静脉泵入,后者在相同时间内应用等量生理盐水,记录术后不同时点患者静脉自控镇痛(PCIA)应用情况,根据目测疼痛评分法(VAS)进行疼痛评分,记录Ramsay镇静评分,采用精神错乱评估法(CAM-ICU)诊断谵妄,观察谵妄发生率。结果 两组患者在入ICU即刻、术后6 h、12 h,静脉自控镇痛泵的总按压次数、有效按压次数、用药量、SpO₂和术后疼痛评分比较,差异均无统计学意义;盐酸右美托咪定组患者术后6 h、12 h心率和平均动脉压低于对照组,镇静评分高于同时间点对照组,盐酸右美托咪定组术后8~12 h CRP值低于对照组,6 h及12 h内睡眠时间长于对照组,差异均有统计学意义(P＜0.05);盐酸右美托咪定组术后12 h内出现谵妄7例(10.14%),对照组20例(29.85%),盐酸右美托咪定组谵妄发生率低于对照组,差异有统计学意义(P＜0.05)。结论 术后静脉持续输注盐酸右美托咪定可降低老年髋部骨折患者术后12 h内谵妄的发生率。     

Value of Doppler sonography in revealing transjugular intrahepatic portosystemic shunt malfunction: a 5-year experience in 216 patients

OBJECTIVE: The purpose of the study was to evaluate the long-term clinical efficacy of Doppler sonography in revealing failure of transjugular intrahepatic portosystemic shunts (TIPS). SUBJECTS AND METHODS: During a 5-year period, 1192 Doppler examinations were performed in 216 patients with TIPS. No regular follow-up shunt venography was performed. Doppler examinations were retrospectively compared with the results of shunt revisions. Sonograms with negative findings were compared with the patients' clinical status so that the number of false-negative sonographic findings leading to an episode of shunt failure (recurrence of gastrointestinal bleeding or ascites) could be ascertained. Sonographic parameters assessed included diameter, velocity, flow volume, and congestion index of the portal vein; and shunt velocities. RESULTS: Doppler sonography revealed shunt occlusion in 25 of 26 angiographically proven cases (sensitivity, 96%). The combination of velocity criteria (peak intrashunt velocity > or =250 cm/sec, maximum velocity in the portal third of the shunt < or =50 cm/sec, or maximum portal vein velocity less than or equal to two thirds of the baseline value) revealed shunt stenosis in 103 of 110 cases (sensitivity, 94%). Doppler sonography missed a significant shunt stenosis that led to an episode of gastrointestinal bleeding or ascites recurrence in only seven cases. The congestion index of the portal vein showed significant differences between patent and malfunctioning shunts (p < 0.001). CONCLUSION: Doppler sonography is an effective primary imaging method for long-term follow-up of patients with TIPS.