title: Benign hepatic nodules in Budd-Chiari syndrome: radiologic-pathologic correlation with emphasis on the central scar.
abstract: OBJECTIVE
  The purpose of this study was to determine the imaging features of benign hepatic nodules in patients with Budd-Chiari syndrome and to correlate them with pathologic findings, with special attention placed on the presence of a central scar.
  
  
  METHODS
  Imaging findings of 59 benign hepatic nodules in four patients with chronic Budd-Chiari syndrome were analyzed retrospectively, and radiologic- pathologic correlation was performed in three patients with 50 hepatic nodules who underwent liver transplantation. All patients underwent multiphasic helical CT. In three patients with 29 lesions, MR imaging, including a multiphasic dynamic study, was performed. The CT and MR imaging findings in these patients were compared with those of 103 small hepatocellular carcinomas in 56 other patients (54 of them displayed chronic hepatitis or liver cirrhosis associated with viral hepatitis but none had Budd-Chiari syndrome). Image analysis was performed by two radiologists with no knowledge of the diagnosis.
  
  
  RESULTS
  All patients with Budd-Chiari syndrome exhibited multiple benign nodules up to 3 cm in diameter, and 42 of 59 lesions were hypervascular. Microscopically, 15 of 32 nodules demonstrated a central scar; moreover, some nodules closely resembled focal nodular hyperplasia. Frequencies of hyperintensity on T1-weighted images (14/29 vs 25/103), hypointensity on T2-weighted images (7/29 vs 1/103), and the presence of a central scar (6/59 vs 1/103) were significantly higher in benign nodules than in hepatocellular carcinomas (p < 0.05; Fisher's exact test). Moreover, for lesions larger than 1 cm, imaging studies revealed a central scar in six of 15 benign lesions.
  
  
  CONCLUSIONS
  Benign hepatic nodules in patients with in Budd-Chiari syndrome are usually small, multiple, and hypervascular. The presence of a central scar is a characteristic feature in those larger than 1 cm in diameter.
authors.affiliation: Department of Radiology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Maetani
authors.forename: Kyo
authors.initials: K
authors.lastname: Itoh
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Hironori
authors.initials: H
authors.lastname: Haga
authors.forename: Takaki
authors.initials: T
authors.lastname: Sakurai
authors.forename: Naoshi
authors.initials: N
authors.lastname: Nishida
authors.forename: Fumie
authors.initials: F
authors.lastname: Ametani
authors.forename: Toshiya
authors.initials: T
authors.lastname: Shibata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubo
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
authors.forename: Junji
authors.initials: J
authors.lastname: Konishi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006502:Budd-Chiari Syndrome / Q000150:complications*; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D002908:Chronic Disease; D005260:Female; D018466:Gravity Sensing; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008107:Liver Diseases / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed