COLOR DOPPLER IMAGING FINDINGS IN PATIENTS WITH BUDD-CHIARI SYNDROME - CORRELATION WITH VENOGRAPHIC FINDINGS

OBJECTIVE. This study was undertaken to evaluate color Doppler imaging findings in patients with Budd-Chiari syndrome and to compare these f indings with results of venography. SUBJECTS AND METHODS. In a prospec tive study, 21 patients with proved Budd-Chiari syndrome had color Dop pler imaging. Sonographic evaluations ware performed to detect appropr iately directed flow in the hepatic veins, portal vein, and inferior v ena cava. Intrahepatic collaterals were characterized when present. Re sults of color Doppler imaging were compared with those of angiography in 20 patients. Color Doppler images of the hepatic veins were also o btained in a reference group (20 control subjects, 20 patients with he patomegaly, and 20 patients with cirrhosis). RESULTS. Color Doppler im aging showed abnormalities of anatomy or flow in one or more of the ma in hepatic veins in all 21 patients with Budd-Chiari syndrome. Commonl y observed abnormalities were visualization of a hepatic vein on real- time sonograms that had no flow or retrograde flow on color Doppler so nograms (11 cases) and no visualization of part or all of a hepatic ve in on either real-time or color Doppler sonograms (10 cases). When com pared with venographic findings (16 patients), findings on color Doppl er sonograms could be used to distinguish patent from occluded hepatic veins in all cases. In our reference group, real-time and color Doppl er sonograms showed normal hepatic veins in all control subjects. Real -time sonograms clearly showed hepatic veins in 12 of 20 patients with hepatomegaly; color Doppler sonograms showed flow in the hepatic vein s in all 20 of these patients. Among 20 patients with cirrhosis, real- time sonograms showed hepatic veins in only seven; color Doppler imagi ng confirmed patent veins in 17. Intrahepatic collaterals typical of B udd-Chiari syndrome were observed in 10 of 21 patients with the syndro me. The portal vein was assessed by using color Doppler imaging in all 21 patients with Budd-Chiari syndrome; portograms were available for comparison in 10 patients. Findings were consistent in eight; in two c ases, the direction of flow was reversed on color Doppler sonograms co mpared with portograms. For the inferior vena cava, venographic and so nographic findings correlated in 16 of 20 cases. Color Doppler sonogra ms did not show a caval web in one patient. CONCLUSION. Abnormalities of the hepatic veins, portal veins, and inferior vena cava detected on color Doppler sonograms in patients with Budd-Chiari syndrome correla te well with findings on venograms. The presence of intrahepatic colla teral vessels may be important in distinguishing patients with Budd-Ch iari syndrome from those who have cirrhosis or inconspicuous hepatic v eins.