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Large Regenerative Nodules in Budd-Chiari Syndrome and Other Vascular Disorders of the Liver

CT and MR Imaging Findings with Clinicopathologic Correlation

Giuseppe Brancatelli1, Michael P. Federle1, Luigi Grazioli2, Rita Golfieri3 and Riccardo Lencioni4

1 Department of Radiology, University of Pittsburgh Medical Center, UPMC-Presbyterian, 200 Lothrop St., Pittsburgh, PA 15213.
2 Department of Radiology, University of Brescia, Italy.
3 Department of Radiology, University of Bologna, Italy.
4 Department of Radiology, University of Pisa, Italy.



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  		Fig. 1A. —34-year-old woman with subacute (25 days' duration) Budd-Chiari syndrome who has large regenerative nodules. Transverse contrast-enhanced helical CT scan obtained in hepatic arterial phase shows multiple small hyperattenuating lesions (straight arrows) with marked homogeneous enhancement. Ascites (A) and recanalized umbilical vein (curved arrow) can also be seen.

 


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  		Fig. 1B. —34-year-old woman with subacute (25 days' duration) Budd-Chiari syndrome who has large regenerative nodules. Transverse contrast-enhanced helical CT scan obtained in portovenous phase shows that lesions are still hyperattenuating (arrows), and liver shows heterogeneous patchy enhancement.

 


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  		Fig. 2. —12-year-old girl with large regenerative nodules who underwent previous portoenterostomy (Kasai procedure) because of biliary atresia. Transverse arterial phase helical CT scan shows partially exophytic hyperattenuating lesion (arrow) with homogeneous enhancement. Splenomegaly and varices (V) can be seen, although they are more evident on other sections (not shown).

 


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  		Fig. 3A. —28-year-old woman with chronic (2 years' duration) Budd-Chiari syndrome who has large regenerative nodules. Transverse contrast-enhanced helical CT scan obtained during hepatic arterial phase shows multiple hyperattenuating lesions (long arrows) with marked enhancement and peripheral hypoattenuating rim (short arrows).

 


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  		Fig. 3B. —28-year-old woman with chronic (2 years' duration) Budd-Chiari syndrome who has large regenerative nodules. Transverse unenhanced T1-weighted gradient-echo MR image (TR/TE, 170/4.2; flip angle, 90°) shows peripheral rim of hyperintensity (arrows) around isointense lesion.

 


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  		Fig. 3C. —28-year-old woman with chronic (2 years' duration) Budd-Chiari syndrome who has large regenerative nodules. Transverse T1-weighted gradient-echo MR image (170/4.2; 90°) obtained during arterial phase of enhancement shows multiple hyperintense lesions (arrows) with marked homogeneous enhancement and peripheral hypointense rim.

 


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  		Fig. 3D. —28-year-old woman with chronic (2 years' duration) Budd-Chiari syndrome who has large regenerative nodules. Transverse T1-weighted gradient-echo MR image (170/4.2; 90°) obtained during portal phase of enhancement. Single slightly hyperattenuating lesion can be seen (arrow) with hypoattenuating ring. Other lesions have become isointense to liver parenchyma.

 


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  		Fig. 3E. —28-year-old woman with chronic (2 years' duration) Budd-Chiari syndrome who has large regenerative nodules. Transverse T2-weighted fat-saturation MR image (4500/100) shows single hypointense lesion (arrow).

 


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  		Fig. 4A. —36-year-old asymptomatic woman with congenital absence of portal vein and large regenerative nodules. Transverse T2-weighted MR image (TR/TE, 4000/80) shows only one of many nodules (arrow), as hypointense lesion.

 


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  		Fig. 4B. —36-year-old asymptomatic woman with congenital absence of portal vein and large regenerative nodules. Transverse gradient-echo T1-weighted MR image (120/4; flip angle, 80°) obtained in arterial phase 25 sec after bolus administration of gadopentetate dimeglumine reveals many more nodules, as brightly enhancing hyperintense lesions (long arrows), some with peripheral hypointense rim (short arrows).

 


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  		Fig. 4C. —36-year-old asymptomatic woman with congenital absence of portal vein and large regenerative nodules. Transverse T1-weighted fat saturation gradient-echo MR image (107/4.8; 75°) obtained 3 hr after administration of gadobenate dimeglumine shows peripheral or homogeneous (arrows) enhancement of nodules, indicating their hepatocellular nature and delayed excretion from nodules.

 

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