Diagnostic and Interventional Radiology for Budd-Chiari Syndrome
 (a) Cavogram obtained before transjugular intrahepatic portosystemic shunt (TIPS) creation in a 24-year-old woman with Budd-Chiari syndrome and a history of oral contraceptive use depicts a reversible intrahepatic inferior vena cava (IVC) stenosis (*). The presence of perilumbar and azygos collateral veins (arrows) is indicative of hemodynamically significant caval narrowing. (b) Cavogram obtained two months after TIPS creation shows resolution of the intrahepatic IVC stenosis and decompression of venous outflow, findings that correlated with a decrease in the portosystemic gradient from 20 to 6 mm Hg. Comparison of photomicrographs of liver biopsy specimens obtained before (c) and two months after (d) TIPS creation shows post-treatment resolution of perivenular congestion with residual sinusoidal dilatation. (RadioGraphics 2009;29:669–681) © RSNA, 2009. All rights reserved. Printed with permission. |
A pathological disorder with multiple causes, Budd-Chiari syndrome is the result of partial or complete obstruction of hepatic venous outflow. Because clinical manifestations are often nonspecific, imaging may be critical for early diagnosis of venous obstruction and accurate assessment of disease extent.
In the May-June issue of RadioGraphics (RSNA.org/radiographics), Marco Cura, M.D., of The University of Texas Health Science Center, and colleagues describe and illustrate the clinical, pathologic and venographic features of the syndrome and discuss possible outcomes after treatment with medical, surgical and endovascular methods.
Specifically, the authors explain:
• Indications for a particular method of treatment
• How a transjugular intrahepatic portosystemic shunt works to treat the syndrome
Authors stress the necessity of comprehensive imaging—in combination with pathologic analyses and clinical testing—in determining disease severity, stratifying risk, selecting the appropriate therapy and objectively assessing the response.
"Clinical and imaging evaluations and histologic analyses of liver biopsy specimens obtained in patients in whom the presence of Budd-Chiari syndrome is suspected play an important role in the detection and classification of the disease, helping guide case management at presentation and providing valuable information at post-treatment follow-up," the authors conclude.
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Vessel Growth and Function: Depiction with Contrast-enhanced MR Imaging
MR imaging not only depicts established and developing vasculature but also can be used to investigate blood vessel growth at different spatial and temporal scales. Recent experimental evidence also demonstrates molecular characterization of neovascularization with MR imaging.
 Maximum intensity projection from high-spatial-resolution (166 × 206 × 320 µm) whole-body contrast-enhanced MR angiography of nude mouse with subcutaneous tumor on its flank (arrow). Medium-molecular-sized contrast agent was used. Blood vessels can be observed in tumor periphery. (Radiology 2009;251:317-335) © RSNA, 2009. All rights reserved. Printed with permission. |
In an article in the May issue of Radiology (RSNA.org/radiology), Marlies Oostendorp, M.Sc., Mark J. Post, M.D., Ph.D., and Walter H. Backes, Ph.D., of Maastricht University Medical Center and Eindhoven University of Technology in The Netherlands, review current contrast-enhanced (CE) MR imaging techniques for depicting established and developing vasculature. The authors describe the basic principles, potential acquisition and interpretation pitfalls, solutions and applications and specifically address:
• Morphologic imaging (CE MR angiography and vessel size imaging)
• Functional imaging (dynamic CE MR imaging and myocardial perfusion imaging)
• Molecular imaging (cellular imaging)
The authors also explain current shortcomings and the impact of future developments on the visualization of blood vessel growth and function with CE MR imaging. CE MR imaging is suitable for depicting both established and developing vasculature at morphologic, functional and molecular levels, authors conclude.
"The ability to detect these diverse aspects of neovascularization makes CE MR imaging, in theory, attractive to follow the entire time course of neovascularization, from the first onset until the establishment of a functional mature vasculature," they conclude. "It is expected that CE MR imaging will further grow in importance to address advanced scientific and clinical needs concerning vessel growth and to depict vessels at a submillimeter resolution."
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