Budd-Chiari syndrome with occlusion of hepatic vein: multi-slice spiral CT diagnosis and its clinical significance in the treatment

Abstract

To evaluate the multi-slice spiral CT dynamic enhancement features and the diagnostic value of CT angiography in Budd-Chiari syndrome with occlusion of hepatic vein (HVBCS), and to assess the CT clinical significance in the treatment of HVBCS. Twenty-one patients with HVBCS confirmed by digital subtraction angiography (DSA) were retrospectively analyzed. All patients received multi-slice spiral dynamic enhancement scans within 2 weeks before DSA. The relevant vein vessels were reconstructed respectively with Maximum Intensity Projection (MIP), Volume Rendering (VR) and Oblique Reformat techniques. The course of disease was less than three months in four patients, more than three months in seventeen patients. In the four patients with the course of disease of less than three months, CT showed global liver enlargement with diffuse hypodensity on plain scans and patchy enhancement in caudate lobe and perihilar areas on post-contrast CT scans, and the enhancement field spread to larger area as the time of scans delayed. In the seventeen patients with the course of disease of more than three months, plain CT scans showed abnormalities of liver morphology and hypodensity either in atrophic areas or in the periphery of the liver. On post-contrast CT scans, the hypodensity areas showed poor and heterogeneous enhancement, and hepatic drainage veins in these areas obstructed, whereas in hepatic veins drainage normal areas hepatic parenchymal showed homogeneous enhancement, their drainage veins had at least one patent hepatic vein or a dilated accessory hepatic vein that can provide adequate collaterals. Hepatic CT enhancement features were closely related to the occlusion location of hepatic vein and collateral drainage veins. In twenty-one patients, a total of 42 hepatic veins were occluded. Among them, 9 left hepatic veins, 12 middle hepatic veins, 16 right hepatic veins, and 6 accessory hepatic veins were occluded. The accuracy rate of hepatic veins occlusion showed on transverse scans and CT angiography were 61.9% and 100% respectively. Multi-slice spiral dynamic enhancement scans can accurately reflect the changes of intrahepatic hymodynamics. Transverse scans combined with CT angiography can explicitly show the location of hepatic veins occlusion and collateral circulation in HVBCS, which is of important clinical significance in the treatment of HVBCS.