Budd-Chiari syndrome: diagnosis with three-dimensional contrast-enhanced magnetic resonance angiography.
OBJECTIVE
To evaluate the role of three-dimensional contrast-enhanced magnetic resonance angiography (3D CE MRA) in the diagnosis of Budd-Chiari syndrome (BCS).


METHODS
Twenty-three patients with BCS underwent 3D CE MRA examination, in which 13 cases were secondary to either hepatocellular carcinoma (11 cases), right adrenal carcinoma (1 case) or thrombophlebitis (1 case) and 10 suffered from primary BCS. The patency of the inferior vena cava (IVC), hepatic and portal veins as well as the presence of intra- and extrahepatic collaterals, liver parenchymal abnormalities and porto-systemic varices were evaluated. Inferior vena cavography was performed in 10 cases. The diagnosis of IVC obstruction by 3D CE MRA was compared with that demonstrated by inferior vena cavography.


RESULTS
The major features of BCS could be clearly displayed on 3D CE MRA. Positive hepatic venous signs included tumor thrombosis (9 cases), tumor compression (2 cases), nonvisualization (4 cases) and focal stenosis (2 cases). Positive IVC findings were noted as severe stenosis or occlusion (10 cases), tumor invasion (2 cases), thrombosis (3 cases), thrombophlebitis (1 case) and septum formation (3 cases). Intrahepatic collaterals were shown in 9 patients, 2 of them with "spider web" sign. The displayed extrahepatic collaterals included dilated azygos and hemi-azygos veins (13 cases) and left renal-inferior phrenic-pericardiophrenic veins (2 cases). The occlusion of the left intrahepatic portal veins was found in 2 cases. Porto-systemic varices were detected in 10 patients. Liver parenchymal abnormalities displayed by 3D CE MRA were enlargement of the caudate lobe (7 cases), heterogenous enhancement (18 cases) and complicated tumors (13 cases). Compared with the inferior vena cavography performed in 10 cases, the accuracy of 3D CE MRA was 100 % in the diagnosis of IVC obstruction.


CONCLUSIONS
3D CE MRA can display the major features of BCS and provide an accurate diagnosis.
Lin
Jiang
J
Department of Radiology, Affiliated Zhongshan Hospital, Fudan University, Shanghai 200032, China. linjiang@zshospital.net
Chen
Xiao-Hai
XH
Zhou
Kang-Rong
KR
Chen
Zu-Wang
ZW
Wang
Jian-Hua
JH
Yan
Zhi-Ping
ZP
Wang
Ping
P
D000328:Adult; D006502:Budd-Chiari Syndrome / Q000473:pathology*; D003287:Contrast Media; D005260:Female; D006503:Hepatic Veins / Q000473:pathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008099:Liver / Q000098:blood supply / Q000473:pathology; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology; D014682:Vena Cava, Inferior / Q000473:pathology
D003287:Contrast Media