Multiphasic Gadolinium Enhanced Magnetic Resonance Imaging in Hepatic Veno- Occlusive Disorders of Paediatric Patients: A Way Forward

Abstract

Background: Budd Chiari syndrome and hepatic veno-occlusive disorders have major implications in paediatric patients as they can lead to cirrhosis. There is a need to establish the role of imaging in early lesion detection and characterization, particularly exploring the role of multiphasic magnetic resonance imaging
(MRI).
Objective: To determine the role of ultrasound and multiphasic MRI in paediatric patients with Budd Chiari syndrome or clinically suspected hepatic veno-occlusive disorder. Patients And Methods: A descriptive cross sectional study was conducted in the department of Diagnostic Radiology, CH and ICH Lahore. A total of 41 patients with known history of Budd Chiari syndrome or clinically suspected cases of hepatic venous outflow occlusion are included in the study. Each patient underwent ultrasound and Contrast enhanced Multiphasic MRI.
Results: Data analysis showed that ultrasound detected cirrhotic liver texture in 61% patients, caudate lobe hypertrophy in 24%, splenomegaly in 58%, ascites in 44 %, narrowing of IVC in 29%, hepatic vein thrombosis in 44% and hepatic focal lesions in only 0.2% patients. MRI detected cirrhotic liver texture in 53% patients, caudate lobe hypertrophy in 26%, splenomegaly in 58%, ascites in 44 %, narrowing of IVC in 44%, hepatic vein thrombosis in 73% and hepatic focal lesions in 7% patients. Multiphasic MRI has a higher sensitivity in detecting the changes particularly hepatic vein thrombosis and hepatic focal lesions.
Conclusion: Multiphasic MRI has better diagnostic yield in cases of Hepatic veno-occlusive diseases particularly in detecting venous thrombosis and hepatic focal lesions in the background of cirrhotic liver.