What question did this study set out to answer?

This research aims to assess the utility of splenic stiffness measured by elastography as a noninvasive method to evaluate TIPS function.

July 8, 2026Open Access

Utility of Splenic Stiffness as a Noninvasive Tool for Evaluating TIPS: A Reliable and Reproducible Method for Identifying Dysfunction

SBSushant BabbarDayanand Medical College & Hospital YPYashwant PatıdarInstitute of Liver and Biliary Sciences AMAmar MukundInstitute of Liver and Biliary Sciences

Key Points

This research aims to assess the utility of splenic stiffness measured by elastography as a noninvasive method to evaluate TIPS function.
Measured splenic stiffness in 27 patients using 2D shear wave elastography and color Doppler ultrasound pre- and post-TIPS procedure.
Performed ROC curve analysis comparing splenic stiffness in patients with normal TIPS function and those with dysfunction.
Evaluated correlation of splenic stiffness with HVPG and direct portal pressure.
Splenic stiffness decreased by 42.1% immediately and 53.5% by one month post-procedure.
Identified TIPS dysfunction in 7 patients at 2 months, with SS showing 92.3% sensitivity and 89.4% specificity for dysfunction at a cutoff of 33.4 kPa.
SS correlated positively with HVPG (R = 0.57, p = 0.02) and direct portal pressure (R = 0.53, p = 0.004).

Abstract

Abstract The effectiveness of transjugular intrahepatic portosystemic shunt (TIPS) in managing adverse effects stemming from portal hypertension has been well-documented, showcasing remarkable outcomes. Direct portal pressure or hepatic venous pressure gradient (HVPG) with venography is the current gold standard for evaluation of TIPS function. These methods being invasive, a search for noninvasive and easily available tool like splenic stiffens as an alternative to look for TIPS function is studied. Twenty-seven patients (19 undergoing fresh TIPS and 8 patients undergoing revision for tips dysfunction) were included. Splenic stiffness (SS) by two-dimensional (2D) shear wave elastography was measured by two observers, and color Doppler ultrasound (CDUS) evaluation was done in all patients 1 day prior to TIPS procedure and on day 1, 3, 28, and 60 postprocedure. A total of 7 patients having TIPS dysfunction were identified at 2 months. For receiver operating characteristic (ROC) curve analysis, mean SS was calculated in 20 patients with normal TIPS function and 15 (8 undergoing TIPS revision and 7 TIPS dysfunction identified during follow-up) TIPS dysfunction patients. SS showed mean decrease of 42.1% immediately postprocedure and 53.5% at 1 month. SS correlated with HVPG (R = 0.57, p = 0.02) and direct portal pressure (R = 0.53, p = 0.004). Portal vein (PV) velocity showed mean increase of 18.6 cm/s 24 hours postprocedure. In univariate analysis, SS, PV velocity, and flow in the intrahepatic portal vein branches were found to be associated with TIPS dysfunction. ROC curve analysis of combined dysfunction/revision group for SS with cutoff of 33.4 kPa showed a sensitivity of 92.3% and specificity of 89.4% for identifying TIPS dysfunction. SS by 2D shear wave elastography is a noninvasive, reliable, and reproducible method for identifying TIPS dysfunction and has a positive correlation with HVPG and direct portal pressure. When done in conjunction with CDUS evaluation, the overall diagnostic accuracy for TIPS assessment increases.

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