Hepatobiliary MR contrast agents are useful to diagnose hepatocellular carcinoma in patients with Budd-Chiari syndrome

Abstract Objective To evaluate the value of hepatobiliary phase (HBP) images todiscriminate benign from malignant lesions in patients with Budd-Chiari syndrome (BCS). Methods This retrospective study included all patients admitted to our institution with a diagnosis of BCS and focal liver lesions on hepatobiliary contrast agent enhanced-MR imaging (HBCA-MRI) from 2000 to 2019. MR images were reviewed by two radiologists blinded to the diagnosis of the lesions. Patient and lesion characteristics were recorded, focusing on the features on HBP images. Lesions were compared using Chi-2, Fisher, Student t or Mann-Whitney tests. Results Twenty-six patients (mean 35±11 years old [13-65], 21 women (81%) 35±12 years old [13-65]; 5 men (19%) 36±10 years old [19-44]) with 99 benign liver lesions and 12 hepatocellular carcinoma (HCC) were analyzed. Patients with HCC were significantly older than those with benign lesions (mean 50±10 vs. 33±9-years old, p=.003), with higher alpha-fetoprotein (AFP) levels (3/4 [75%] vs. 1/22 [5%] with AFP>15ng/mL, p 15 ng/mL were all HCCs. Discussion Most benign lesions showed homogeneous or peripheral hyperintensity on HBP images while all HCCs were homogeneously hypointense. HBP images are helpful to differentiate between benign lesions and HCCs and outperform other sequences. They should systematically be acquired for the characterization of focal lesions in patients with BCS.