Contrast-enhanced MR angiography of benign regenerative nodules following TIPS shunt procedure in Budd-Chiari syndrome.

In this report we describe the magnetic resonance (MR) angiographic features of benign hepatic nodules that developed in a patient with Budd-Chiari syndrome, and present the distinguishing features of benign regenerative nodules from hepatocellular cancer. In a 27-year-old woman with chronic Budd-Chiari syndrome, previously non-existing benign nodules developed in the liver parenchyma during the 10-month period following transjugular intrahepatic portosystemic (TIPS) shunt placement. The liver had been examined with gray-scale and Doppler sonography in addition to the MR imaging and MR angiography. On MR angiography, more hepatic nodules became visible in the portal venous phase compared to that of the arterial phase. Delayed washout of contrast medium in nodules was considered to be due to stasis in hepatic sinusoids. Hypervascularization, appearance after portosystemic shunt creation, multiplicity, small size ( <=2 cm in diameter in our patient), presence of peripheral rim, and high signal intensity on T1-weighted images are important imaging features of benign hepatic nodules that develop in patients with Budd-Chiari syndrome.