Budd-Chiari Syndrome and hepatic regenerative nodules: Magnetic resonance findings with emphasis of hepatobiliary phase

• Published in: European journal of radiology 2019-08, Vol.117, p.15-25
• Main Authors: Mamone, Giuseppe, Carollo, Vincenzo, Di Piazza, Ambra, Cortis, Kelvin, Degiorgio, Sarah, Miraglia, Roberto
• Format: Article
• Language: English
• Subjects: Budd-Chiari Syndrome; Budd-Chiari Syndrome - diagnostic imaging; Budd-Chiari Syndrome - pathology; Carcinoma, Hepatocellular - diagnostic imaging; Carcinoma, Hepatocellular - pathology; Contrast Media; Female; FNH-like lesions; Hepatobiliary imaging; Humans; Large regenerative nodules; Liver - pathology; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - pathology; Magnetic Resonance Imaging; Male; Middle Aged; MRI
• ISSN: 0720-048X; 1872-7727
• DOI: 10.1016/j.ejrad.2019.05.015

•In chronic Budd-Chiari syndrome, benign regenerative nodules and hepatocellular carcinoma (HCC) have been described in the literature.•These regenerative nodules have been called “large regenerative nodules” or alternatively “FNH-like lesions”, because they strongly resemble FNH.•The typical MRI features of FNH-like regenerative nodules help to reach the correct diagnosis.•FNH-like regenerative nodules can show atypical imaging finding and different pattern in the same liver.•Since HCC can develop in patients with chronic BCS, it is pivotal to distinguish FNH-like RNs from HCC because treatment is radically different. Budd-Chiari syndrome (BCS) is a disorder with numerous causes that is a result of hepatic outflow obstruction, in the absence of right heart failure or constrictive pericarditis. Acute Budd-Chiari syndrome is uncommon and clinically characterized by ascites, hepatomegaly, and hepatic insufficiency. In the majority of cases, patients present with chronic BCS, showing a dysmorphic liver disease with variable fibrosis deposition. In chronic Budd-Chiari syndrome, hepatocellular carcinoma (HCC) and benign regenerative nodules (called large regenerative nodules or FNH-like lesions) have been described in the literature. Very few studies have reported magnetic resonance imaging (MRI) findings about these nodules, using hepatobiliary contrast medium. The aim of our review is to describe the magnetic resonance imaging findings of hepatic regenerative nodules in BCS, with emphasis on the hepatobiliary phase, and to compare the imaging features of benign nodules with those of HCC.