AJR:178, April 2002 869 Benign Hepatic Nodules in Budd-Chiari Syndrome: Radiologic–Pathologic Correlation with Emphasis on the Central Scar OBJECTIVE. The purpose of this study was to determine the imaging features of benign hepatic nodules in patients with Budd-Chiari syndrome and to correlate them with pathologic findings, with special attention placed on the presence of a central scar. MATERIALS AND METHODS. Imaging findings of 59 benign hepatic nodules in four patients with chronic Budd-Chiari syndrome were analyzed retrospectively, and radiologic– pathologic correlation was performed in three patients with 50 hepatic nodules who under- went liver transplantation. All patients underwent multiphasic helical CT. In three patients with 29 lesions, MR imaging, including a multiphasic dynamic study, was performed. The CT and MR imaging findings in these patients were compared with those of 103 small hepatocel- lular carcinomas in 56 other patients (54 of them displayed chronic hepatitis or liver cirrhosis associated with viral hepatitis but none had Budd-Chiari syndrome). Image analysis was per- formed by two radiologists with no knowledge of the diagnosis. RESULTS. All patients with Budd-Chiari syndrome exhibited multiple benign nodules up to 3 cm in diameter, and 42 of 59 lesions were hypervascular. Microscopically, 15 of 32 nod- ules demonstrated a central scar; moreover, some nodules closely resembled focal nodular hy- perplasia. Frequencies of hyperintensity on T1-weighted images (14/29 vs 25/103), hypointensity on T2-weighted images (7/29 vs 1/103), and the presence of a central scar (6/59 vs 1/103) were significantly higher in benign nodules than in hepatocellular carcinomas ( p < 0.05; Fisher’s exact test). Moreover, for lesions larger than 1 cm, imaging studies revealed a central scar in six of 15 benign lesions. CONCLUSION. Benign hepatic nodules in patients with in Budd-Chiari syndrome are usually small, multiple, and hypervascular. The presence of a central scar is a characteristic feature in those larger than 1 cm in diameter. udd-Chiari syndrome is a disorder resulting from gross outflow block to hepatic veins with numerous causes. The liver in patients with Budd-Chiari syndrome is known to develop severe conges- tion, fibrosis, and cirrhosis [1]. In association with Budd-Chiari syndrome, benign regenera- tive nodules, termed adenomatous hyperplastic nodules [2], nodular regenerative hyperplasia [3–5], and regenerative nodules [6–9] have been described in the literature. On pathologic exam- ination, benign nodules of greater than 5 mm in diameter have been observed in 60–80% of pa- tients with Budd-Chiari syndrome [7, 8]. De- spite this fact, only a few studies have reported imaging findings regarding these lesions. In patients with chronic Budd-Chiari syn- drome, hepatocellular carcinoma also can develop [10, 11], and it is important to distin- guish benign hepatic nodules from hepato- cellular carcinoma because treatment differs radically. On radiologic examination, both benign nodules and hepatocellular carci- noma have been reported as hypervascular [6]. On the other hand, benign nodules com- posed of fairly normal hepatocytes often have a central scar and resemble focal nodu- lar hyperplasia pathologically [7–9]. There- fore, the presence of a central scar may suggest benignity. However, to our knowl- edge, no radiologic study has documented the presence of a central scar of benign le- sions in Budd-Chiari syndrome. In addition, the incidence of central scars in hepatocellu- lar carcinoma remains unclear. The purpose of our investigation was to describe the im- aging appearance of benign hepatic nodules in Budd-Chiari syndrome and to compare it Yoji Maetani 1 Kyo Itoh 2 Hiroto Egawa 3 Hironori Haga 4 Takaki Sakurai 5 Naoshi Nishida 6 Fumie Ametani 1 Toshiya Shibata 2 Takeshi Kubo 1 Koichi Tanaka 3 Junji Konishi 1 1 Department of Radiology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, Japan, 606-8507. Address correspondence to Y. Maetani. 2 Department of Radiology, Kyoto University Hospital, Kyoto, Japan, 606-8507. 3 Department of Transplantation Immunology and Transplant Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan, 606-8507. 4 Organ Transplantation Unit, Kyoto University Hospital, Kyoto, Japan, 606-8507. 5 Laboratory of Pathology, Kyoto Katsura Hospital, 17 Yamada Hirao-cho, Nishikyo-ku, Kyoto, Japan. 6 Department of Medicine and Clinical Science, Kyoto University Hospital, Kyoto, Japan, 606-8507. AJR 2002;178:869–875 0361–803X/02/1784–869 © American Roentgen Ray Society B Downloaded from www.ajronline.org by 52.73.204.196 on 05/17/22 from IP address 52.73.204.196. Copyright ARRS. For personal use only; all rights reserved