Introduction The incidence of hepatocellular carcinoma (HCC) in Budd-Chiari syndrome (BCS) is unknown and there is no validated diagnostic work-up to define the liver nodules with arterial phase hyperenhancement (APHE), suggesting malignancy. This prospective study evaluates HCC incidence in a Western cohort of patients with BCS and assesses the performance of MRI with hepatobiliary contrast (HB-MRI) for nodule characterization. Methods Patients with BCS followed in our hospital were prospectively evaluated by MRI with extracellular contrast (EC-MRI). Nodules with APHE categorized as non-conclusively benign by 2 radiologists were studied by HB-MRI and reviewed by 2 radiologists blinded to the EC-MRI results. A new EC-MRI 1 year later and clinical, analytical, and sonographic follow-up every 6 months for a median of 10 years was performed. Results A total of 55 non-conclusively benign nodules with APHE were detected at EC-MRI in 41 patients. While 32 of them were suggestive of HCC by EC-MRI, all the 55 nodules showed increased uptake of hepatobiliary contrast. An unequivocal central scar was seen in 12/55 nodules at HB-MRI regardless of it was not detected on the EC-MRI. None of the nodules was hypointense in the hepatobiliary phase (HBP). HCC was not detected during a median of 10 years of follow-up. Conclusions Detection of nodules with APHE is frequent in patients with BCS, but HCC is rare in Western patients with BCS. While EC-MRI may detect nodules suggesting malignancy, the identification of contrast uptake in the HBP at HB-MRI may help categorize them as benign.

中文翻译：

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使用 MRI 使用钆塞酸检查布加氏综合征中未确定为良性的肝结节：前瞻性长期随访。


简介 布加综合征 (BCS) 中肝细胞癌 (HCC) 的发病率尚不清楚，并且没有经过验证的诊断检查来定义动脉期过度增强 (APHE) 的肝结节，提示恶性肿瘤。这项前瞻性研究评估了西方 BCS 患者队列中 HCC 的发病率，并评估了 MRI 肝胆造影 (HB-MRI) 对结节特征的表现。方法对我院随访的BCS患者进行细胞外造影MRI（EC-MRI）前瞻性评估。由 2 名放射科医生分类为非结论性良性的 APHE 结节通过 HB-MRI 进行研究，并由 2 名对 EC-MRI 结果不知情的放射科医生进行审查。一年后进行一次新的 EC-MRI，并每 6 个月进行一次临床、分析和超声随访，中位时间为 10 年。结果 EC-MRI 在 41 名患者中总共检测到 55 个非结论性良性 APHE 结节。虽然 EC-MRI 发现其中 32 个结节提示 HCC，但所有 55 个结节均显示肝胆造影剂摄取增加。尽管在 EC-MRI 上未检测到，但 HB-MRI 中 12/55 结节中可见明确的中央疤痕。在肝胆相 (HBP) 中，没有一个结节呈低信号。在中位 10 年的随访期间未检测到 HCC。结论 BCS 患者常检出 APHE 结节，但西方 BCS 患者很少见 HCC。虽然 EC-MRI 可以检测到提​​示恶性肿瘤的结节，但 HB-MRI 中 HBP 中对比剂摄取的识别可能有助于将其分类为良性。