Accuracy of computed tomographic angiography in the diagnosis of patients with inferior vena cava partial obstruction in Budd-Chiari syndrome.
OBJECTIVE
The diagnosis of the partially obstructed inferior vena cava (IVC) in Budd-Chiari syndrome (BCS) patients has received little attention. We aimed to evaluate the diagnostic accuracy of computed tomographic angiography (CTA) for patients with BCS and a partially obstructed IVC.


METHODS
A total of 329 patients with BCS and an obstructed IVC were endovascularly treated with balloon dilation and/or stent placement. All patients underwent a CTA examination prior to endovascular treatment, and the data were retrospectively reviewed. The presence of a round, oval, irregular shape or jet sign low-density area without enhancement within the enhanced proximal IVC was considered a sign of a partially obstructed IVC. Digital subtraction angiography was used as the gold standard.


RESULTS
The results from the digital subtraction angiography revealed a partially obstructed IVC in 108 BCS patients and a complete obstruction in 221 patients. The CTA discovered a partially obstructed IVC in 99 patients and a completely obstructed IVC in 230 patients. From the CTA results, 15 were false negatives, and six were false positives. The patient-based evaluation yielded an accuracy of 93.6%, a sensitivity of 86.1%, specificity of 97.3%, positive predictive value of 93.9%, and negative predictive value of 93.5% for the detection of BCS patients with a partial IVC obstruction.


CONCLUSIONS
Computed tomographic angiography offered a high diagnostic accuracy and sensitivity in BCS patients with a partially obstructed IVC. The low-density area within the enhanced proximal IVC above the membrane in artery phase can be considered a reliable indicator of a stenotic IVC in BCS patients.
Institution of General Surgery, Zhongnan University, Changsha, China.|Department of Intervention, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
Shi-Yi
SY
Liu
Institution of General Surgery, Zhongnan University, Changsha, China.
Ping
P
Xiao
Department of Intervention, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
Hui-Cun
HC
Cao
Department of Intervention, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
Hao-Sheng
HS
Jiang
Department of Intervention, Henan Provincial People's Hospital Affiliated to Zhengzhou University, Zhengzhou, China.
Tian-Xiao
TX
Li
D000293:Adolescent; D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D000800:Angioplasty, Balloon / Q000295:instrumentation; D006502:Budd-Chiari Syndrome / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D002648:Child; D002681:China; D000072226:Computed Tomography Angiography; D003251:Constriction, Pathologic; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D010690:Phlebography / Q000379:methods*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014654:Vascular Patency; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging* / Q000503:physiopathology; D055815:Young Adult
Budd-Chiari syndrome (BCS); computed tomographic angiography (CTA); inferior vena cava (IVC); obstruction; venography