MR-guided transjugular intrahepatic portosystemic shunt creation with use of a hybrid radiography/MR system

PURPOSE: To evaluate the performance of a combined hybrid radiography/magnetic resonance (MR) unit to guide portal vein (PV) puncture during human transjugular intrahepatic portosystemic shunt (TIPS) creation. MATERIALS AND METHODS: Fourteen patients undergoing TIPS creation were studied during standard clinical applications. Patients were anesthetized and then positioned in an open MR unit containing a flat-panel radiographic fluoroscopic unit. With use of a combination of fluoroscopy and MR imaging, the PV was accessed and the TIPS procedure was performed. A noncovered nitinol stent or a covered stent-graft was placed in the TIPS tract. Number of punctures required, total procedure time, fluoroscopy time, procedural success rate, complications, and ultrasonographic and clinical follow-up were recorded. RESULTS: Clinical success was obtained in 13 of 14 patients. In one patient, extrahepatic puncture of the PV occurred, resulting in hemorrhage and requiring placement of a covered stent to control the bleeding. The mean number of punctures required to access the PV was 2.6 ± 1.7, and the total procedure time was 2.5 hours ± 0.6. Mean fluoroscopy time was 22.3 minutes ± 5.5. Results of clinical and ultrasonographic follow-up compare favorably to previously published reports. CONCLUSION: TIPS creation with a combination hybrid radiography/MR unit is feasible and may reduce the number of needle passes required and radiation exposure, with similar overall outcomes compared with studies reported in the literature.