Hepatic nodules in Budd-Chiari syndrome: Imaging features

PURPOSE: To analyze the imaging features of nodules associated with Budd-Ch iari syndrome. MATERIALS AND METHODS: The authors retrospectively studied images obtained in 23 patients with liver nodules who were being followed up for Budd-Chiar i syndrome. Doppler ultrasonography was performed in all patients, computed tomography in 16, and magnetic resonance (MR) imaging in 20. The following lesion features were evaluated: location, number, size, vascularization, q ualitative signal intensity at MR imaging, and homogeneity. Nodules were di agnosed on the basis of histopathologic findings or clinical and biologic d ata with no change at imaging during 2-year follow-up. RESULTS: All patients had histopathologic features of chronic Budd-Chiari s yndrome. Four patients had hepatocellular carcinoma (HCC), with one to thre e lesions. The mean diameter of the largest HCC lesion in each patient was 7.3 cm. All HCC lesions were heterogeneous and had high signal intensity on T2-weighted MR images. Nineteen patients had multiple benign regenerative nodules, most of which were; smaller than 4 cm. Most nodules were homogeneo us and hyperintense on T1- and T2-weighted images. In 15 patients, nodules were hypervascular in the arterial phase. CONCLUSION: In patients with chronic Budd-Chiari syndrome, multiple (>10) s mall (<4-cm) lesions are suggestive of benignity.