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Hepatic Nodules in Budd-Chiari Syndrome: Imaging Features

¹ Departments of Radiology (V.V., M.L., A.D., Y.M.)
² Hepatology (D.V.)
³ Pathology (J.F.F.)
⁴ Digestive Surgery (J.B.), Hôpital Beaujon, 100 bd du General Leclerc, 92118 Clichy, France
⁵ Department of Digestive Surgery, Hôpital Antoine Beclere, Clamart, France (C.V.).

View larger version (17K): [in a new window]   Figure 1. Interval between diagnosis of Budd-Chiari syndrome and lesions.

View larger version (128K): [in a new window]   Figure 2a. HCC. (a) Contrast-enhanced helical CT scan obtained during the hepatic arterial phase shows that the tumor in the left lobe (arrowheads) has heterogeneous enhancement. Dilatation of the azygos (A) and hemiazygos (H) veins is seen. (b) Fast spin-echo T2-weighted MR image (repetition time msec/echo time msec = 3,250/110; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) shows the high-signal-intensity lesion (arrowheads). Ascites and dilatation of the azygos (A) and hemiazygos (H) veins are seen.

View larger version (176K): [in a new window]   Figure 2b. HCC. (a) Contrast-enhanced helical CT scan obtained during the hepatic arterial phase shows that the tumor in the left lobe (arrowheads) has heterogeneous enhancement. Dilatation of the azygos (A) and hemiazygos (H) veins is seen. (b) Fast spin-echo T2-weighted MR image (repetition time msec/echo time msec = 3,250/110; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) shows the high-signal-intensity lesion (arrowheads). Ascites and dilatation of the azygos (A) and hemiazygos (H) veins are seen.

View larger version (147K): [in a new window]   Figure 3a. Benign regenerative nodules. (a) Longitudinal US scan of the right lobe of the liver shows multiple homogeneous and hypoechoic nodules. One nodule is seen between calipers. Ascites (A) is also shown. (b) Unenhanced helical CT scan shows multiple, small, hyperattenuating lesions. Ascites (A) is seen, as is the mesoatrial surgical shunt (S). (c) Contrast-enhanced helical CT scan obtained during the hepatic arterial phase shows that the lesions (arrowheads) have marked homogeneous enhancement. Ascites (A) is seen. The mesoatrial surgical shunt (S) did not enhance after injection of contrast material and was determined to be obstructed.

View larger version (151K): [in a new window]   Figure 3b. Benign regenerative nodules. (a) Longitudinal US scan of the right lobe of the liver shows multiple homogeneous and hypoechoic nodules. One nodule is seen between calipers. Ascites (A) is also shown. (b) Unenhanced helical CT scan shows multiple, small, hyperattenuating lesions. Ascites (A) is seen, as is the mesoatrial surgical shunt (S). (c) Contrast-enhanced helical CT scan obtained during the hepatic arterial phase shows that the lesions (arrowheads) have marked homogeneous enhancement. Ascites (A) is seen. The mesoatrial surgical shunt (S) did not enhance after injection of contrast material and was determined to be obstructed.

View larger version (162K): [in a new window]   Figure 3c. Benign regenerative nodules. (a) Longitudinal US scan of the right lobe of the liver shows multiple homogeneous and hypoechoic nodules. One nodule is seen between calipers. Ascites (A) is also shown. (b) Unenhanced helical CT scan shows multiple, small, hyperattenuating lesions. Ascites (A) is seen, as is the mesoatrial surgical shunt (S). (c) Contrast-enhanced helical CT scan obtained during the hepatic arterial phase shows that the lesions (arrowheads) have marked homogeneous enhancement. Ascites (A) is seen. The mesoatrial surgical shunt (S) did not enhance after injection of contrast material and was determined to be obstructed.

View larger version (130K): [in a new window]   Figure 4a. Benign regenerative nodules. (a) Contrast-enhanced helical CT scan obtained during the hepatic arterial phase shows multiple hyperattenuating masses in the liver. Enlargement of the spleen (Sp) is also shown. (b) Fast spin-echo T2-weighted MR image (4,080/110; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) shows that the lesions (arrowheads) have moderately high signal intensity. The decreased signal intensity in the posterior part of the spleen may be due to the field inhomogeneity of the MR unit. (c) Unenhanced T1-weighted gradient-echo MR image (160/4.9; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) shows multiple hyperintense lesions. (d) Gadolinium-enhanced gradient-echo T1-weighted MR image (160/4.9; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) obtained during the hepatic arterial phase shows that the lesions (arrowheads) have marked enhancement.

View larger version (132K): [in a new window]   Figure 4b. Benign regenerative nodules. (a) Contrast-enhanced helical CT scan obtained during the hepatic arterial phase shows multiple hyperattenuating masses in the liver. Enlargement of the spleen (Sp) is also shown. (b) Fast spin-echo T2-weighted MR image (4,080/110; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) shows that the lesions (arrowheads) have moderately high signal intensity. The decreased signal intensity in the posterior part of the spleen may be due to the field inhomogeneity of the MR unit. (c) Unenhanced T1-weighted gradient-echo MR image (160/4.9; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) shows multiple hyperintense lesions. (d) Gadolinium-enhanced gradient-echo T1-weighted MR image (160/4.9; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) obtained during the hepatic arterial phase shows that the lesions (arrowheads) have marked enhancement.

View larger version (137K): [in a new window]   Figure 4c. Benign regenerative nodules. (a) Contrast-enhanced helical CT scan obtained during the hepatic arterial phase shows multiple hyperattenuating masses in the liver. Enlargement of the spleen (Sp) is also shown. (b) Fast spin-echo T2-weighted MR image (4,080/110; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) shows that the lesions (arrowheads) have moderately high signal intensity. The decreased signal intensity in the posterior part of the spleen may be due to the field inhomogeneity of the MR unit. (c) Unenhanced T1-weighted gradient-echo MR image (160/4.9; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) shows multiple hyperintense lesions. (d) Gadolinium-enhanced gradient-echo T1-weighted MR image (160/4.9; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) obtained during the hepatic arterial phase shows that the lesions (arrowheads) have marked enhancement.

View larger version (128K): [in a new window]   Figure 4d. Benign regenerative nodules. (a) Contrast-enhanced helical CT scan obtained during the hepatic arterial phase shows multiple hyperattenuating masses in the liver. Enlargement of the spleen (Sp) is also shown. (b) Fast spin-echo T2-weighted MR image (4,080/110; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) shows that the lesions (arrowheads) have moderately high signal intensity. The decreased signal intensity in the posterior part of the spleen may be due to the field inhomogeneity of the MR unit. (c) Unenhanced T1-weighted gradient-echo MR image (160/4.9; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) shows multiple hyperintense lesions. (d) Gadolinium-enhanced gradient-echo T1-weighted MR image (160/4.9; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) obtained during the hepatic arterial phase shows that the lesions (arrowheads) have marked enhancement.

View larger version (111K): [in a new window]   Figure 5a. Atypical benign regenerative nodule. (a) T1-weighted spin-echo MR image (450/15; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) shows a large, heterogeneous lesion (arrows) in the right lobe. The lesion is mostly hyperintense and contains hypointense foci. (b) Fast spin-echo T2-weighted MR image (3,480/110; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm). The lesion (arrows) is heterogeneous and has a central area of high signal intensity.

View larger version (117K): [in a new window]   Figure 5b. Atypical benign regenerative nodule. (a) T1-weighted spin-echo MR image (450/15; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm) shows a large, heterogeneous lesion (arrows) in the right lobe. The lesion is mostly hyperintense and contains hypointense foci. (b) Fast spin-echo T2-weighted MR image (3,480/110; matrix, 200 x 256; field of view, 400 mm; section thickness, 10 mm; gap, 2 mm). The lesion (arrows) is heterogeneous and has a central area of high signal intensity.