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Budd–Chiari syndrome: a prospective analysis of hepatic vein obstruction on ultrasonography, multidetector-row computed tomography and MR imaging

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Abstract

Purpose

The goal of this study was to prospectively describe the imaging presentation of hepatic vein (HV) obstruction in patients with Budd–Chiari syndrome (BCS) on duplex and color Doppler ultrasonography (DCD-US), multidetector-row computed tomography (MDCT) and magnetic resonance imaging (MRI).

Materials and methods

A total of 176 patients with primary BCS (mean age, 33 years; 101 women) were prospectively included. BCS diagnosis was made by direct visualization of HV and/or upper portion of the inferior vena cava (IVC) obstruction on DCD-US and/or MDCT and/or MRI. Location (right, middle, and left HV), type (thrombus, stenosis, or both), and age (recent vs. long-standing) of HV obstruction were described on each imaging examination.

Results

HV obstruction was a constant (100%) finding and associated with IVC abnormalities in 51/176 (28.98%) patients. Obstruction of the three HVs was present in 158/176 (89.77%) patients. The prevalences of right, middle, and left HV thrombus were 151/169 (89.35%), 146/169 (86.39%), and 111/169 (65.68%), respectively. Long-standing HV thrombus was observed in more than 92% of patients on the three imaging methods. Agreement between DCD-US, MDCT, and MRI was perfect in the identification of long-standing HV thrombus (κ = 0.9); this agreement was slight to moderate in revealing the type of HV abnormality (i.e., fibrotic cord and non-visible HV).

Conclusion

Our results indicate that BCS is a chronic and insidious disease, more often discovered at an advanced stage. These results should warrant further evaluation of screening strategies in patients with risk factors for BCS to identify the disease at an early stage.

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Abbreviations

BCS:

Budd–Chiari syndrome

HV:

Hepatic vein

IVC:

Inferior vena cava

DCD-US:

Duplex color Doppler ultrasonography

MDCT:

Computed tomography

MRI:

Magnetic resonance imaging

TE:

Echo time

TR:

Repetition time

TSE:

Turbo spin echo

ms:

Milliseconds

KV:

Kilovolts

US:

Ultrasonography

Ns:

Not specified

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Acknowledgment

We thank Boualem Faraoun for excellent technical assistance and critical reading of the manuscript.

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Authors and Affiliations

  1. Department of Radiology, Centre Pierre et Marie Curie, Place du 1er Mai, 16016, Alger, Algeria

    Sid Ahmed Faraoun & Youcef Guerrache

  2. Department of Internal Medicine, Hôpital de Kouba, Alger, Algeria

    Mohamed El Amine Boudjella

  3. Department of Hepatology, CHU Mustapha, Place du 1er Mai, 16016, Alger, Algeria

    Nabil Debzi & Nawel Afredj

  4. Department of Pathology, Hôpital de la SûretéNationale, Alger, Algeria

    Naima Benidir

  5. Department of Surgery, Centre Pierre et Marie Curie, Place du 1er Mai, 16016, Alger, Algeria

    Chafik Bouzid & Kamel Bentabak

  6. Department of Body & Interventional Imaging, Hôpital Lariboisière-APHP & Université Diderot-Paris 7, 2 rue Ambroise Paré, 75010, Paris, France

    Philippe Soyer

  7. Department of Radiology & Université Benyoucef Benkhedda d’Alger, Centre Pierre et Marie Curie, Place du 1er Mai, 16016, Alger, Algeria

    Salah Eddine Bendib

Authors
  1. Sid Ahmed Faraoun
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  2. Mohamed El Amine Boudjella
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  3. Nabil Debzi
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  4. Nawel Afredj
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  5. Youcef Guerrache
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  7. Chafik Bouzid
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  8. Kamel Bentabak
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  9. Philippe Soyer
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  10. Salah Eddine Bendib
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Correspondence to Sid Ahmed Faraoun.

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Faraoun, S.A., Boudjella, M.E.A., Debzi, N. et al. Budd–Chiari syndrome: a prospective analysis of hepatic vein obstruction on ultrasonography, multidetector-row computed tomography and MR imaging. Abdom Imaging 40, 1500–1509 (2015). https://doi.org/10.1007/s00261-015-0380-5

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  • DOI: https://doi.org/10.1007/s00261-015-0380-5

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