Initial Imaging Analysis of Budd-Chiari Syndrome in Henan Province of China: Most Cases Have Combined Inferior Vena Cava and Hepatic Veins Involvement

Abstract

AimTo evaluate the type of venous involvement in Chinese Budd-Chiari syndrome (BCS) patients and the relative diagnostic accuracy of the different imaging modalities.MethodsUsing digital subtraction angiography (DSA) as a reference standard, color Doppler ultrasound (CDUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA) were performed on 338 patients with BCS. We analyzed the course of the main and any accessory hepatic veins (HVs) and the inferior vena cava (IVC) to assess the etiology of obstructed segments and diagnostic accuracy of CDUS, CTA and MRA.ResultsAmong the 338 cases, there were 8 cases (2.4%) of isolated IVC membranous obstruction, 45 cases (13.3%) of isolated HV occlusion, and 285 cases (84.3%) with both IVC membranous obstruction and HV occlusion. Comparing with DSA, CDUS, CTA had a diagnostic accuracy of 89.3% and 80.2% in detecting BCS, and 83.4% of cases correctly correlated by MRA.ConclusionIn Henan Province, most patients with BCS have complex lesions combining IVC and HV involvement. The combination of CDUS and CTA or MRI is useful for diagnosis of BCS and guiding therapy.

Good Clinical Outcomes in Budd–Chiari Syndrome with Hepatic Vein Occlusion

“…In these patients, Doppler ultrasound imaging always shows HV enlargement with stenotic origin, hypoechoic lumen with no or reverse blood flow, and large collateral vessels in the liver, under the liver membrane or in the third hepatic hila. The diameter of the PV does not increase and flow velocity to the liver, decreases or even reverses CT and MR imaging show an enlarged caudate lobe with hyperenhancement due to separate direct drainage into the IVC, nutmeg liver in the PV phase and HV phase, high parenchymal density in the liver center, delayed emptying of contrast agent, porphyritic sign in the perihepatic parenchyma, and nodular hyperplasia in chronic cases [12]. CTA and MRA show an enlarged hepatic artery, small lumen, and stiff walls of hepatic branches of the PV and the dilated or indiscernible HV.…”

Ultrasonographic Visualization of Accessory Hepatic Veins and Their Lesions in Budd–Chiari Syndrome

“…Normally, small anastomoses are found between adjacent AHVs and hepatic veins or between hepatic veins and other hepatic veins. Most patients with BCS have a chronic condition and have hepatic vein obstruction (Gai et al 2014b;Zhou et al 2014). The continuous increased pressure resulting from obstructed hepatic veins may eventually transform the anastomoses into enlarged collaterals.…”

Budd-Chiari Syndrome

“…These changes are more obvious on magnetic resonance (MR), which provides images with far better tissue contrast (Zhou et al, 2014). Invasive imaging methods that can be used to depict obstruction of the venous outflow include angiography of the inferior vena cava and hepatic veins (cavography).…”