Budd-Chiari Syndrome and hepatic regenerative nodules: Magnetic resonance findings with emphasis of hepatobiliary phase

Mamone, Giuseppe; Carollo, Vincenzo; Piazza, Ambra Di; Cortis, Kelvin; Degiorgio, Sarah; Miraglia, Roberto

doi:10.1016/j.ejrad.2019.05.015

Cited by 15 publications

(37 citation statements)

References 31 publications

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“…This was suggested by Mamone et al in a review article. 31 The main challenge is found in lesions with both arterial phase hyperenhancement (whatever the pattern) and washout. As previously shown, most of these tumors are benign but may nevertheless require liver biopsy.…”

Section: Discussionmentioning

confidence: 99%

Hepatobiliary MR contrast agents are useful to diagnose hepatocellular carcinoma in patients with Budd-Chiari syndrome

et al. 2020

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Background & Aims: Hepatobiliary phase (HBP) images can discriminate between benign and malignant liver lesions, but it is unclear if this approach can be used in patients with Budd-Chiari syndrome (BCS). Thus, we aimed to assess the diagnostic utility of HBP images in patients with BCS. Methods: This retrospective study included all patients admitted to our institution with a diagnosis of BCS and focal liver lesions on hepatobiliary contrast agent-enhanced MR imaging (HBCA-MRI) from 2000 to 2019. MR images were reviewed by 2 radiologists blinded to the diagnosis of the lesions. Patient and lesion characteristics were recorded, focusing on HBP imaging features. Results: Twenty-six patients (mean 35 ± 11 years old ; 21 women [81%] 35 ± 12 years old [13-65]; 5 men [19%] 36 ± 10 years old ) with 99 benign liver lesions and 12 hepatocellular carcinomas (HCCs) were analyzed. Patients with HCC were significantly older than those with benign lesions (mean 50 ± 10 vs. 33 ± 9 years old, p = 0.003), with higher alphafetoprotein (AFP) levels (3/4 [75%] vs. 1/22 [5%] with AFP >15 ng/ml, p <0.001). Homogeneous hypointense signals were identified on HBP in 14 lesions, including 12/12 (100%) HCCs, and 2/99 (2%) benign lesions (p <0.001). Most benign liver lesions showed either peripheral (n = 52/99 [53%]) or homogeneous hyperintensity (n = 23/99 [23%]) on HBP. Lesions with signal hypointensity on HBP in patients with AFP serum levels >15 ng/ml were all HCCs. Conclusion: Most benign lesions showed homogeneous or peripheral hyperintensity on HBP images while all HCCs were homogeneously hypointense. HBP images are helpful to differentiate between benign lesions and HCCs and outperform other sequences. They should be systematically acquired for the characterization of focal lesions in patients with BCS.

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Section: Discussionmentioning

confidence: 99%

Hepatobiliary MR contrast agents are useful to diagnose hepatocellular carcinoma in patients with Budd-Chiari syndrome

et al. 2020

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“…7)-if the lesion is larger. Of note, Mamone et al [59] have recently described the possibility of FNH-like lesions showing hypointensity on HBP and suggested as a potential explanation, either a different OATP1B3 expression in hepatocytes or the presence of areas of abnormal hepatic perfusion/ congestion.…”

Section: Patients With Vascular Liver Disordersmentioning

confidence: 99%

Spectrum of liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting

et al. 2021

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Hepatobiliary MRI contrast agents are increasingly being used for liver imaging. In clinical practice, most focal liver lesions do not uptake hepatobiliary contrast agents. Less commonly, hepatic lesions may show variable signal characteristics on hepatobiliary phase. This pictorial essay reviews a broad spectrum of benign and malignant focal hepatic observations that may show hyperintensity on hepatobiliary phase in various clinical settings. In non-cirrhotic patients, focal hepatic observations that show hyperintensity in the hepatobiliary phase are usually benign and typically include focal nodular hyperplasia. In patients with primary or secondary vascular disorders, focal nodular hyperplasia-like lesions arise as a local hyperplastic response to vascular alterations and tend to be iso- or hyperintense in the hepatobiliary phase. In oncologic patients, metastases and cholangiocarcinoma are hypointense lesions in the hepatobiliary phase; however, occasionally they may show a diffuse, central and inhomogeneous hepatobiliary paradoxical uptake with peripheral rim hypointensity. Post-chemotherapy focal nodular hyperplasia-like lesions may be tricky, and their typical hyperintense rim in the hepatobiliary phase is very helpful for the differential diagnosis with metastases. In cirrhotic patients, hepatocellular carcinoma may occasionally appear hyperintense on hepatobiliary phase.

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“…The diagnosis of BCS is based on the presence of clinical and laboratory findings, associated with radiological evidence of partial or complete venous drainage impairment. Many conditions can lead to BCS, and the site of the obstruction ranges from the smaller hepatic venules to the cavo-atrial junction or the right atrium [ 5 , 6 , 7 ]. Notably, only hepatic venous outflow tract obstruction of major veins can be visualized on imaging, while small hepatic veins obstruction (known as small vessel BCS) can only be diagnosed on histology [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…Notably, only hepatic venous outflow tract obstruction of major veins can be visualized on imaging, while small hepatic veins obstruction (known as small vessel BCS) can only be diagnosed on histology [ 8 ]. By contrast, in the sinusoidal obstruction syndrome (SOS), previously called veno-occlusive disease, the outflow obstruction arises at level of the sinusoids and terminal hepatic venules rather than the hepatic veins [ 6 ]. This latter represents a distinct entity and will not be described, as it eludes from the purposes of this review.…”

Section: Introductionmentioning

confidence: 99%

Budd-Chiari Syndrome Imaging Diagnosis: State of the Art and Future Perspectives

2023

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Budd-Chiari syndrome (BCS) is a rare hepatic vascular disorder defined by the presence of partial or complete impairment of hepatic venous drainage in the absence of right heart failure or constrictive pericarditis. Several conditions can lead to BCS, from hypercoagulable states to malignancies. Primary BCS is the most common subtype, and usually bartends hypercoagulability states, while secondary BCS involves tumor invasion or extrinsic compression. A combination of clinical and imaging features leads to the diagnosis of BCS, including (1) direct signs: occlusion or compression of the hepatic veins and/or inferior vena cava, and the presence of venous collaterals; (2) indirect signs: morphological hepatic changes with caudate lobe enlargement; inhomogeneous enhancement, and hypervascular nodules. From a clinicopathological point of view, two forms of BCS can be distinguished: acute and subacute/chronic BCS, although asymptomatic and fulminant forms are also possible. Acute presentations are rare, and symptoms include hepatomegaly, ascites, and hepatic insufficiency. Subacute/chronic forms are the most common presentation, with dysmorphic liver and variable degrees of fibrosis deposition. Patients with chronic BCS can develop benign regenerative nodules (large regenerative nodules or FNH [Focal Nodular Hyperplasia]-like lesions), but are also at a higher risk of hepatocellular carcinoma (HCC). The radiologist role is therefore fundamental in both diagnosis and surveillance of BCS. The aim of this review is to present all clinical and imaging signs that can help to reach the diagnosis of BCS, with their clinical significance, providing tips and tricks for the cross-sectional diagnosis of this condition.

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Budd-Chiari Syndrome and hepatic regenerative nodules: Magnetic resonance findings with emphasis of hepatobiliary phase

Cited by 15 publications

References 31 publications

Hepatobiliary MR contrast agents are useful to diagnose hepatocellular carcinoma in patients with Budd-Chiari syndrome

Hepatobiliary MR contrast agents are useful to diagnose hepatocellular carcinoma in patients with Budd-Chiari syndrome

Spectrum of liver lesions hyperintense on hepatobiliary phase: an approach by clinical setting

Budd-Chiari Syndrome Imaging Diagnosis: State of the Art and Future Perspectives

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