gadoxetic-acid-disodium and Budd-Chiari-Syndrome

Pancreatitis may induce a spectrum of venous and arterial vascular complications. However, hepatic infarction complicated with acute pancreatitis seldom occurs because of the unique vascular configuration of the liver. We herein describe an extremely rare and unique case in which simultaneous portal vein and hepatic vein thrombosis were present. We precisely assessed both hepatic hemodynamics and hepatocellular function using sequential multidetector computed tomography and gadoxetate disodium-enhanced magnetic resonance imaging, which may provide useful information on the pathophysiological state and diagnosis of hepatic infarction.

Topics: Aged; Budd-Chiari Syndrome; Contrast Media; Diagnosis, Differential; Female; Follow-Up Studies; Gadolinium DTPA; Humans; Image Enhancement; Infarction; Liver; Magnetic Resonance Imaging; Multidetector Computed Tomography; Pancreatitis, Acute Necrotizing; Reproducibility of Results; Retrospective Studies

Topics: Adolescent; Budd-Chiari Syndrome; Contrast Media; Diagnosis, Differential; Female; Focal Nodular Hyperplasia; Follow-Up Studies; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Liver; Liver Failure, Acute; Liver Function Tests; Magnetic Resonance Imaging; Portasystemic Shunt, Transjugular Intrahepatic; Postoperative Complications; Tomography, X-Ray Computed; Ultrasonography

Budd-Chiari syndrome (BCS) is a rare disorder caused by the obstruction of hepatic venous outflow, leading to sinusoidal congestion, ischemic injury to liver cells and portal hypertension. Long-term survival largely depends on whether hepatocellular carcinoma occurs. A recently available liver-specific contrast medium, gadolinium-ethoxybenzyl-diethylenetriamine penta-acetic acid (Gd-EOB-DTPA), reportedly has high diagnostic capability for detection of malignant liver tumors. However, there has been no report of the sue of Gd-EOB-DTPA-enhanced magnetic resonance imaging (MRI) for BCS. We present a case of chronic BCS who underwent both gadopentetate dimeglumine (Gd-DTPA) and Gd-EOB-DTPA-enhanced MRI. Hepatic congestion and edema were seen as slightly hypointense areas on Gd-EOB-DTPA-enhanced hepatobiliary-phase images, although these areas were observed as slightly hyperintense on previously obtained Gd-DTPA-enhanced delayed-phase image. Reduced uptake of Gd-EOB-DTPA by hepatocytes in the region of congestion or edema may account for this difference, which should be recognized in image interpretations.

Topics: Adult; Budd-Chiari Syndrome; Contrast Media; Edema; Female; Gadolinium DTPA; Humans; Image Processing, Computer-Assisted; Liver; Liver Neoplasms; Magnetic Resonance Imaging; Tomography, X-Ray Computed

Large regenerative nodules (LRNs) are hyperplastic benign nodules most commonly associated with Budd-Chiari syndrome (BCS), caused by outflow obstruction of the hepatic veins or vena cava. To our knowledge, no cases of LRNs arising in BCS after transjugular intrahepatic portosystemic shunt (TIPS) positioning and detected by Gd-EOB-DTPA MRI have been reported in the literature.. A 58-year-old woman with BCS, on the liver transplantation (LT) list, underwent a follow-up enhanced MRI. Two years earlier, a TIPS had been placed. In 2008, recurrent hepaticoencephalopathy resistant to medical treatment fulfilled the LT criteria for BCS treated with TIPS and the patient was therefore added to the LT list. CT performed before TIPS had not detected any hepatic lesions. CT performed six months after TIPS showed its complete patency but documented two indeterminate hypervascular liver lesions.. MRI performed with Gd-EOB-DTPA revealed additional hypervascular lesions with uptake and retention of the medium in the hepatobiliary phase, thus reflecting a benign behavior of hepatocellular composition. These MRI features were related to LRNs as confirmed by histopathologic analysis.. Gd-EOB-DTPA-enhanced MRI is potentially superior to standard imaging using gadolinium chelates or spiral CT, especially for the differential diagnosis of hypervascular lesions. Gd-EOB-DTPA MRI may become the imaging method of choice for evaluating LT list patients with BCS after TIPS placement.

Topics: Budd-Chiari Syndrome; Contrast Media; Female; Gadolinium DTPA; Humans; Liver; Liver Transplantation; Magnetic Resonance Imaging; Middle Aged; Portasystemic Shunt, Transjugular Intrahepatic; Predictive Value of Tests; Regeneration; Tomography, X-Ray Computed; Waiting Lists