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Abstract
B
CS is an uncommon but potentially life-threating disorder caused by obstruction of the hepatic venous outflow at any level from the small hepatic veins to the junction of ivc with the right atrium.
Diagnosis of BCS requires high index of suspicion. Abnormal liver function tests are not specific for BCS. Thus, the diagnosis is largely made by imaging studies.
The aim beyond this study was to describe and analyse the different radiologic findings in the relevant imaging techniques and to evaluate their role in diagnosis of BCS.
The relevant imaging techniques that were included in the current study were: pulsed color duplex Doppler ultrsonography, multislice triphasic CT scan with portography and three dimentional MR venography and portography
To fulfill such purpose, the current study was conducted on 25 patients with any circumstance suggestive for diagnosis of BCS.
All patients were subjected to detailed history taking and clinical examination. Then a complete examination of the upper abdomen with the 3 studied imagings was done for the recruited patients starting with Doppler ultrasonography followed by examination with MSCT and MRV with special reference to the patency and patterns of occlusion of [the hepatic veins (HVs) {majorandaccessory hepatic veins}, the collateral circulation and the IVC)] portal vein, hepatic parenchymatus changes, splenic size and status of ascites]. Doppler signals from all major hepatic veins and the portal vein were obtained.
Then all recruited patients proved by imaging to have BCS were subjected to laboratory investigations aiming at assessment of liver disease severity, exclusion of other etiologies of liver disease and identification of the etiology of BCS. Our patients also underwent upper gastrointestinal endoscopy to evaluate the status of varices and portal hypertensive gastropathy.
The results showed that there was statistically significant positive correlation between Doppler U/S and MRV regarding their capability of visualization of the same patterns of occlusion of the right HV. This positive correlation was very highly significant when dealing with the middle hepatic vein. However, the results of these two techniques were not matching when we considered the left hepatic vein and the difference was highly significant.
We found statistically highly significant difference between Doppler U/S and MSCT regarding their capability of visualization of the different patterns of occlusion of the right, middle and left HVs.
Also, there was statistically significant difference, statistically highly significant difference, and statistically very highly significant difference between MSCT and MRV with the latter being superior to MSCT as regards the capability of visualization of different patterns of occlusion and patency of the right, middle and left HVs respectively.
Our results showed also that both Doppler ultrasonography and MRV were superior to MSCT as regards the capability of visualization of the accessory hepatic veins including inferior RT HV and caudate vein.
Doppler ultrasonography was the most superior studied imaging regarding the capability of visualization of the intrahepatic collaterals with insignificant coorelation between Doppler U/S and MRV regarding this point. Also, there was no statistically significant difference between MSCT and MRV in visualization of intrahepatic collaterals.
MSCT and MRV were superior to Doppler Ultrasonography regarding the capability of delineation of the extrahepatic collaterals especially the retroperitoneal collaterals.
The three studied imagings were capable of documentation of the patency of the portal vein equally in 24 cases and occlusion of the portal vein in the remaining case.
Again, Doppler ultrasonography was unique regarding its capability of demonstration the flow and its pattern in HVs and portal vein.
In the current study, it was found that there was no statistically significant difference between the 3 studied imagings as regards visualization and assessment of patency of the suprahepatic and retrohepatic portion of the IVC.
However, some findings like compression of the IVC by enlarged caudate lobe (which appears as a smooth narrowing) and stenosis of the IVC were delineated more acurrately at MSCT and MRV than at Doppler ultrsonography.
Regarding morphological changes of the hepatic parenchyma in BCS (e.g. enhancement pattern, perfusion changes of the hepatic parenchyma and demonstration of the regenerative nodules), MSCT and MRV were superior to Doppler ultrasonography.