Comparative study of MRI manifestations of acute and chronic Budd–Chiari syndrome

Magnetic resonance imaging (MRI) is able to diagnose Budd–Chiari syndrome (BCS) by distinguishing differential imaging features of acute and chronic forms of the disease. However, the characteristic imaging differences are still not clear as previous data were mostly obtained from scattered small samples instead of large comparative study.

To investigate MRI manifestations of acute and chronic (BCS), and to evaluate the value of MRI for diagnosis of acute and chronic BCS.

We retrospectively compared MRI results of 24 patients with acute and 82 patients with chronic BCS using Mann–Whitney U test for ascites volume, and Fisher’s exact test for intrahepatic venous collaterals and extra-hepatic venous collaterals. In the acute group, MRI findings suggested thrombosis in hepatic vein (HV) in all acute patients and additional inferior vena cava (IVC) thrombosis in 5 patients. In the chronic BCS group, 6 and 15 patients showed solitary obstruction either in the IVC or HV, respectively, while 61 patients showed combined IVC and HV obstruction. More patients with acute BCS presented with ascites accompanied with high signals on T2WI from intravenous obstructive lesions. Further, the average maximal spleen diameter in patients with acute BCS, and the ratio of patients with acute BCS developing intrahepatic venous collaterals and extra-hepatic venous collaterals were also lower compared with chronic BCS. All these differences were statistically significant.

MRI indicates direct and indirect features of BCS, and therefore enables accurate diagnosis of acute and chronic BCS.