MR imaging features and long-term evolution of benign focal liver lesions in Budd-Chiari syndrome and Fontan-associated liver disease - 13/10/21

Doi : 10.1016/j.diii.2021.09.001

Nicola Panvini ^a, Marco Dioguardi Burgio ^a,^b,^⁎ , Riccardo Sartoris ^a,^b, Cesare Maino ^a, Morgane Van Wettere ^a,^b, Aurélie Plessier ^b,^c, Audrey Payancé ^c, Pierre-Emmanuel Rautou ^b,^c, Magalie Ladouceur ^d, Valérie Vilgrain ^a,^b, Maxime Ronot ^a,^b
^a Department of Radiology, Beaujon Hospital, APHP.Nord, 92110 Clichy, France
^b Université de Paris, Centre de recherche sur l'inflammation, Inserm, U1149, CNRS, ERL8252, 75010 Paris, France
^c Department of Hepatology, Beaujon Hospital, APHP.Nord, 92110 Clichy, France
^d Unité Médico-Chirurgicale de Cardiologie Congénitale et Pédiatrique, Centre de Référence des Malformations Congénitales Cardiaques Complexes, Hôpital Européen Georges-Pompidou, APHP.Centre, 75015 Paris, France

^⁎Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 13 October 2021
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Highlights

•	Nodules in Budd-Chiari syndrome and Fontan-associated liver disease show differences on magnetic resonance imaging at diagnosis and during follow-up.
•	Nodules in Budd-Chiari syndrome exhibit more changes in size and imaging features over time.
•	Almost half of the nodules in Fontan-associated liver disease do not show any changes follow-up.

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Abstract

Purpose

To compare the magnetic resonance imaging (MRI) features of benign liver lesions developed on Budd-Chiari syndrome (BCS) with those on Fontan-associated liver disease (FALD) and to describe their long-term progression.

Materials and methods

Patients with BCS or FALD who underwent MRI between 2010 and 2020 were retrospectively included. MRI features of nodules (≥ 5 mm) at baseline and at final follow-up were reviewed. The final diagnosis of benign lesion was based on a combination of clinical and biological data and findings at follow-up MRI examination.

Results

Two-hundred and thirty benign liver lesions in 39 patients with BCS (10 men, 29 women; mean age, 36 ± 11 [SD] years; age range: 15–66 years) and 84 benign lesions in 14 patients with FALD (2 men, 12 women; mean age, 31 ± 10 [SD] years; age range: 20–48 years) were evaluated. On baseline MRI, BCS nodules were more frequently hyperintense on T1-weighted (183/230, 80%) and hypointense on T2-weighted (142/230; 62%) images, while FALD nodules were usually isointense on both T1- (70/84; 83%) and T2-weighted (64/84; 76%) images (all P< 0.01). Most lesions showed arterial phase hyperenhancement (222/230 [97%] vs. 80/84 [95%] in BCS and FALD, respectively; P = 0.28) but wash-out was more common in BCS (64/230 [28%] vs. 9/84 [11%]; P < 0.01). At follow-up, changes were more frequent in BCS nodules with more frequent disappearance (P < 0.01), changes in size, signal intensity on T2-weighted, portal, and delayed phase, and in the depiction of washout and capsule (all P ≤ 0.03).

Conclusion

MRI features of benign lesions are different at diagnosis and during the course of the disease between BCS and FALD. Changes in size and MRI features are more frequent in benign lesions developed in BCS.

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Keywords : Budd-Chiari syndrome, Hepatic venous outflow obstruction, Liver neoplasms, Magnetic resonance imaging, Follow-up studies

Abbreviations : AFP, APHE, BCS, FALD, HCA, HCC, MRI, SD, WI