Magnetic Resonance Venography Findings of Obstructed Hepatic Veins and the Inferior Vena Cava in Patients with Budd-Chiari Syndrome

Abstract

Objective: This study aimed to illustrate the magnetic resonance venography (MRV) manifestations of obstructed hepatic veins (HVs), the inferior vena cava (IVC), and accessory hepatic veins (AHVs) in patients with Budd-Chiari syndrome (BCS) and to evaluate the visualization capacity of MRV in the diagnosis of BCS.

Materials and methods: Fifty-two patients with chronic BCS were included in this study. All patients were examined via MRV performed with a 3T system following injections of gadolinium-diethylene triamine pentaacetic acid (Gd-DTPA) or Gd-ethoxibenzyl-DTPA. HV and IVC lesions were classified, and their characteristics were described. HV cord-like occlusions detected via MRV were compared using ultrasonography (US). Digital subtraction angiography (DSA) was performed as a contrast in the MRV detection of IVC lesions. The HVs draining collaterals, mainly AHVs, were carefully observed. HV lesions were classified as segmental stenosis, segmental occlusion, membranous stenosis, membranous occlusion, cord-like occlusion, or non-visualized. Except for patent IVCs, IVC lesions were classified as segmental occlusion, segmental stenosis, membranous occlusion, membranous stenosis, and hepatomegaly-induced stenosis.

Results: All patients (52/52, 100%) showed HV lesions of different degrees. MRV was inferior to US in detecting cord-like occlusions (6 vs. 19, χ² = 11.077, p < 0.001). Dilated AHVs, including 50 (50/52, 96.2%) caudate lobe veins and 37 (37/52, 71.2%) inferior HV and AHV lesions, were well-detected. There were no significant differences in detecting segmental lesions and thrombosis between MRV and DSA (χ² = 0.000, p1 = 1.000, p2 = 1.000). The capacity of MRV to detect membranous lesions was inferior to that of DSA (7 vs. 15, χ² = 6.125, p = 0.013).

Conclusion: In patients with BCS, MRV can clearly display the lesions in HVs and the IVC, as well as in AHVs, and it has diagnostic and therapeutic value.

Keywords: Angiography; Budd-Chiari syndrome; Hepatic vein; Inferior vena cava; MOVC; Magnetic resonance imaging; Venography.

Fig. 1. Segmental occlusions.

Proximal parts of three HVs show segmental obstruction (arrows), with blood draining through caudate lobe vein. HV = hepatic vein, LHV = left hepatic vein, MHV = middle hepatic vein, RHV = right hepatic vein

Fig. 2. Hepatomegaly induced stenosis.

MRV shows intumescent caudate lobe and compressed IVC lumen (arrows). IVC = inferior vena cava, MRV = magnetic resonance venography

Fig. 3. Partial thrombosis.

MRV shows blood-filling defects in inferior RHVs (white arrow) and IVC (black arrow), which were partly thrombosed.

Fig. 4. Cord-like occlusion.

A. MRV shows hypo-intense cord at original HV anatomic site (arrows). B. Ultrasonogram shows HV cord-like occlusion (arrow) in liver parenchyma of same patient.

Fig. 5. Membranous stenosis.

Caudate lobe vein shows membranous stenosis (arrow) with ejecting blood into pouch. CLV = caudate lobe vein

Fig. 6. Dilated accessory hepatic veins.

Two figures are not same patient. MRV shows segmental occlusion of IVC (white arrow) and dilated inferior right hepatic (black arrow) (A) and caudate lobe veins (B), which drain blood into IVC in third portal of liver.

Fig. 7. Membranous occlusion.

A. MRV shows membranous occlusion (arrow) of IVC without blood passage. B. Digital subtraction angiography confirms presence of membrane (arrow) shown on angiogram performed through internal jugular and transfemoral veins.