Imaging modalities recommended for diagnosing hepatic vein obstruction in suspected Budd-Chiari syndrome primarily include Doppler ultrasound as the first-line investigation, followed by cross-sectional imaging such as contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) for further evaluation.
Doppler ultrasound is the initial preferred modality due to its non-invasiveness, accessibility, and ability to assess hepatic vein patency, flow direction, and detect thrombus or obstruction effectively. It can also evaluate collateral venous pathways and liver parenchymal changes associated with Budd-Chiari syndrome NICE NG158 Chaubal et al. 2006.
When ultrasound findings are inconclusive or to better delineate the extent of hepatic vein and inferior vena cava involvement, contrast-enhanced CT or MRI is recommended. These modalities provide detailed anatomical visualization of hepatic veins, inferior vena cava, and liver parenchyma, and can identify associated focal liver lesions or complications NICE NG158 Bansal et al. 2018Rizzetto et al. 2023.
Magnetic resonance venography (MRV) is particularly useful for non-invasive vascular mapping without ionizing radiation and can complement ultrasound findings, especially in complex cases Bansal et al. 2018.
In summary, the diagnostic pathway integrates Doppler ultrasound as the frontline tool, with CT or MRI reserved for confirmation, detailed assessment, or when ultrasound is insufficient NICE NG158 Chaubal et al. 2006Bansal et al. 2018Rizzetto et al. 2023.
Key References
- NG158 - Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
- NG50 - Cirrhosis in over 16s: assessment and management
- NG224 - Urinary tract infection in under 16s: diagnosis and management
- (Chaubal et al., 2006): Sonography in Budd-Chiari syndrome.
- (Bansal et al., 2018): Budd-Chiari syndrome: imaging review.
- (Rizzetto et al., 2023): Focal Liver Lesions in Budd-Chiari Syndrome: Spectrum of Imaging Findings.