{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:29:24Z","timestamp":1777422564981,"version":"3.51.4"},"reference-count":52,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2023,7,12]],"date-time":"2023-07-12T00:00:00Z","timestamp":1689120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Budd\u2013Chiari syndrome (BCS) is a rare clinical entity characterized by hepatic venous outflow obstruction, resulting in liver congestion and subsequent chronic parenchymal damage. This condition often leads to the development of focal liver lesions, including benign focal nodular hyperplasia-like regenerative nodules, hepatocellular carcinoma, and perfusion-related pseudo-lesions. Computed tomography, ultrasound, and magnetic resonance are the commonly employed imaging modalities for the follow-up of BCS patients and for the detection and characterization of new-onset lesions. The accurate differentiation between benign and malignant nodules is crucial for optimal patient management and treatment planning. However, it can be challenging due to the variable and overlapping characteristics observed. This review aims to provide a comprehensive overview of the imaging features and differential diagnosis of focal liver lesions in BCS, emphasizing the key findings and discussing the challenges associated with their interpretation, with the purpose of facilitating the subsequent clinical decision-making.<\/jats:p>","DOI":"10.3390\/diagnostics13142346","type":"journal-article","created":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T01:52:25Z","timestamp":1689213145000},"page":"2346","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Focal Liver Lesions in Budd-Chiari Syndrome: Spectrum of Imaging Findings"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3451-9874","authenticated-orcid":false,"given":"Francesco","family":"Rizzetto","sequence":"first","affiliation":[{"name":"Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"},{"name":"Postgraduate School of Diagnostic and Interventional Radiology, Universit\u00e0 degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Rutanni","sequence":"additional","affiliation":[{"name":"Postgraduate School of Diagnostic and Interventional Radiology, Universit\u00e0 degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6852-6314","authenticated-orcid":false,"given":"Luca Alessandro","family":"Carbonaro","sequence":"additional","affiliation":[{"name":"Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"},{"name":"Department of Oncology and Hemato-Oncology, Universit\u00e0 degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2452-3370","authenticated-orcid":false,"given":"Angelo","family":"Vanzulli","sequence":"additional","affiliation":[{"name":"Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy"},{"name":"Department of Oncology and Hemato-Oncology, Universit\u00e0 degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1056\/NEJMra2207738","article-title":"Primary Budd\u2013Chiari Syndrome","volume":"388","author":"Valla","year":"2023","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"874","DOI":"10.4254\/wjh.v7.i6.874","article-title":"Liver Cirrhosis in Hepatic Vena Cava Syndrome (or Membranous Obstruction of Inferior Vena Cava)","volume":"7","author":"Shrestha","year":"2015","journal-title":"World J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2693","DOI":"10.3748\/wjg.v13.i19.2693","article-title":"Budd-Chiari Syndrome: Etiology, Pathogenesis and Diagnosis","volume":"13","author":"Aydinli","year":"2007","journal-title":"World J. Gastroenterol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1053\/jhep.2003.50076","article-title":"Arterial and Portal Circulation and Parenchymal Changes in Budd-Chiari Syndrome: A Study in 17 Explanted Livers","volume":"37","year":"2003","journal-title":"Hepatology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1148\/radiology.210.2.r99fe13443","article-title":"Hepatic Nodules in Budd-Chiari Syndrome: Imaging Features","volume":"210","author":"Vilgrain","year":"1999","journal-title":"Radiology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.diii.2021.09.001","article-title":"MR Imaging Features and Long-Term Evolution of Benign Focal Liver Lesions in Budd-Chiari Syndrome and Fontan-Associated Liver Disease","volume":"103","author":"Panvini","year":"2022","journal-title":"Diagn. Interv. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1002\/hep.510270224","article-title":"Pathology of the Liver in Budd-Chiari Syndrome: Portal Vein Thrombosis and the Histogenesis of Veno-Centric Cirrhosis, Veno-Portal Cirrhosis, and Large Regenerative Nodules","volume":"27","author":"Tanaka","year":"1998","journal-title":"Hepatology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"89","DOI":"10.3350\/cmh.2015.21.1.89","article-title":"Budd-Chiari Syndrome with Multiple Large Regenerative Nodules","volume":"21","author":"Kim","year":"2015","journal-title":"Clin. Mol. Hepatol."},{"key":"ref_9","first-page":"I139","article-title":"Regenerative Nodules in Budd Chiari Syndrome","volume":"19","author":"Wanless","year":"1994","journal-title":"Hepatology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"869","DOI":"10.2214\/ajr.178.4.1780869","article-title":"Benign Hepatic Nodules in Budd-Chiari Syndrome: Radiologic-Pathologic Correlation with Emphasis on the Central Scar","volume":"178","author":"Maetani","year":"2002","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"International Working Party (1995). Terminology of Nodular Hepatocellular Lesions. Hepatology, 22, 983\u2013993.","DOI":"10.1016\/0270-9139(95)90324-0"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.ejrad.2019.05.015","article-title":"Budd-Chiari Syndrome and Hepatic Regenerative Nodules: Magnetic Resonance Findings with Emphasis of Hepatobiliary Phase","volume":"117","author":"Mamone","year":"2019","journal-title":"Eur. J. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1111\/j.1365-2559.2004.01795.x","article-title":"Focal Hyperplastic Hepatocellular Nodules in Hepatic Venous Outflow Obstruction: A Clinicopathological Study of Four Patients and 24 Nodules","volume":"44","author":"Ibarrola","year":"2004","journal-title":"Histopathology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"877","DOI":"10.2214\/ajr.178.4.1780877","article-title":"Large Regenerative Nodules in Budd-Chiari Syndrome and Other Vascular Disorders of the Liver: CT and MR Imaging Findings with Clinicopathologic Correlation","volume":"178","author":"Brancatelli","year":"2002","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.ejrad.2009.01.012","article-title":"Regenerative Nodules in Patients with Chronic Budd-Chiari Syndrome: A Longitudinal Study Using Multiphase Contrast-Enhanced Multidetector CT","volume":"73","author":"Flor","year":"2010","journal-title":"Eur. J. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/j.jhep.2019.01.009","article-title":"Low Specificity of Washout to Diagnose Hepatocellular Carcinoma in Nodules Showing Arterial Hyperenhancement in Patients with Budd-Chiari Syndrome","volume":"70","author":"Purcell","year":"2019","journal-title":"J. Hepatol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.2214\/ajr.181.6.1811641","article-title":"Sonography of the Caudate Vein: Value in Diagnosing Budd-Chiari Syndrome","volume":"181","author":"Gilabert","year":"2003","journal-title":"Am. J. Roentgenol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1148\/radiographics.22.4.g02jl17847","article-title":"Benign Regenerative Nodules in Budd-Chiari Syndrome and Other Vascular Disorders of the Liver: Radiologic-Pathologic and Clinical Correlation","volume":"22","author":"Brancatelli","year":"2002","journal-title":"Radiographics"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/0168-8278(91)90904-P","article-title":"Nodular Regenerative Hyperplasia of the Liver and the Budd-Chiari Syndrome","volume":"12","author":"Portmann","year":"1991","journal-title":"J. Hepatol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/j.clinimag.2016.01.006","article-title":"Budd-Chiari Syndrome: An Update on Imaging Features","volume":"40","author":"Faraoun","year":"2016","journal-title":"Clin. Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/S1499-3872(11)60075-1","article-title":"Large Regenerative Nodules in a Patient with Budd-Chiari Syndrome after TIPS Positioning While on the Liver Transplantation List Diagnosed by Gd-EOB-DTPA MRI","volume":"10","author":"Renzulli","year":"2011","journal-title":"Hepatobiliary Pancreat. Dis. Int."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"100097","DOI":"10.1016\/j.jhepr.2020.100097","article-title":"Hepatobiliary MR Contrast Agents Are Useful to Diagnose Hepatocellular Carcinoma in Patients with Budd-Chiari Syndrome","volume":"2","author":"Paulatto","year":"2020","journal-title":"JHEP Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1097\/00004728-199301000-00015","article-title":"MRI of Adenomatous Hyperplastic Nodules of the Liver in Budd-Chiari Syndrome","volume":"17","author":"Soyer","year":"1993","journal-title":"J. Comput. Assist. Tomogr."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1007\/s002610000027","article-title":"Nodular Regenerative Hyperplasia of the Liver in Budd-Chiari Syndrome: CT and MR Features","volume":"25","author":"Rha","year":"2000","journal-title":"Abdom. Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1007\/s002610000078","article-title":"Benign Regenerative Nodules with Copper Accumulation in a Case of Chronic Budd-Chiari Syndrome: CT and MR Findings","volume":"25","author":"Soler","year":"2000","journal-title":"Abdom. Imaging"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1148\/radiology.178.2.1846240","article-title":"Benign and Malignant Nodules in Cirrhotic Livers: Distinction Based on Blood Supply","volume":"178","author":"Matsui","year":"1991","journal-title":"Radiology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1007\/s00261-018-1502-7","article-title":"Benign and Malignant Hepatocellular Lesions in Patients with Vascular Liver Diseases","volume":"43","author":"Vilgrain","year":"2018","journal-title":"Abdom. Radiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2625","DOI":"10.1007\/s00261-018-1744-4","article-title":"White Paper of the Society of Abdominal Radiology Hepatocellular Carcinoma Diagnosis Disease-Focused Panel on LI-RADS V2018 for CT and MRI","volume":"43","author":"Elsayes","year":"2018","journal-title":"Abdom. Radiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1002\/hep.29913","article-title":"Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases","volume":"68","author":"Marrero","year":"2018","journal-title":"Hepatology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jhep.2018.03.019","article-title":"EASL Clinical Practice Guidelines: Management of Hepatocellular Carcinoma","volume":"69","author":"Galle","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1055\/a-0647-1658","article-title":"Ultrasonography in Liver Vascular Disease","volume":"39","author":"Berzigotti","year":"2018","journal-title":"Ultraschall Der Med. Eur. J. Ultrasound"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2984","DOI":"10.1016\/j.ejrad.2012.01.023","article-title":"Comparison of Imaging Characteristics between Hepatic Benign Regenerative Nodules and Hepatocellular Carcinomas Associated with Budd-Chiari Syndrome by Contrast Enhanced Ultrasound","volume":"81","author":"Zhang","year":"2012","journal-title":"Eur. J. Radiol."},{"key":"ref_33","first-page":"685486","article-title":"Multiple FNH-Like Lesions in a Patient with Chronic Budd-Chiari Syndrome: Gd-EOB-Enhanced MRI and BR1 CEUS Findings","volume":"2012","author":"Newerla","year":"2012","journal-title":"Case Rep. Radiol."},{"key":"ref_34","first-page":"249","article-title":"Radiological Study of Idiopathic Budd-Chiari Syndrome Complicated by Hepatocellular Carcinoma. A Report of Four Cases","volume":"89","author":"Takayasu","year":"1994","journal-title":"Am. J. Gastroenterol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1111\/apt.13173","article-title":"Incidence and Risk Factors of Hepatocellular Carcinoma in Patients with Hepatic Venous Outflow Tract Obstruction","volume":"41","author":"Paul","year":"2015","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1097\/MEG.0b013e32835eb8d4","article-title":"Prevalence and Risk Factors of Hepatocellular Carcinoma in Budd-Chiari Syndrome: A Systematic Review","volume":"25","author":"Ren","year":"2013","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Wester, A., \u00c5berg, F., Rajani, R., and Hagstr\u00f6m, H. (Clin. Gastroenterol. Hepatol., 2022). Minimal Risk of Hepatocellular Carcinoma in Noncirrhotic Budd-Chiari Syndrome: A Three-Decade Population-Based Study, Clin. Gastroenterol. Hepatol., in press.","DOI":"10.1016\/j.cgh.2022.08.042"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"191","DOI":"10.3904\/kjim.2003.18.3.191","article-title":"Rapidly Progressing Budd-Chiari Syndrome Complicated by Hepatocellular Carcinoma","volume":"18","author":"Jang","year":"2003","journal-title":"Korean J. Intern. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/0016-5085(82)90001-4","article-title":"Membranous Obstruction of the Inferior Vena Cava and Hepatocellular Carcinoma in South Africa","volume":"82","author":"Simson","year":"1982","journal-title":"Gastroenterology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1075685","DOI":"10.3389\/fonc.2022.1075685","article-title":"Budd-Chiari Syndrome and Its Associated Hepatocellular Carcinoma: Clinical Risk Factors and Potential Immunotherapeutic Benefit Analysis","volume":"12","author":"Li","year":"2022","journal-title":"Front. Oncol."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Hoshida, Y. (2019). Hepatocellular Carcinoma: Translational Precision Medicine Approaches, Springer International Publishing. Molecular and Translational Medicine.","DOI":"10.1007\/978-3-030-21540-8"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1148\/rg.210156","article-title":"Focal Nodular Hyperplasia and Focal Nodular Hyperplasia\u2013like Lesions","volume":"42","author":"Legout","year":"2022","journal-title":"Radiographics"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2214","DOI":"10.1111\/liv.14223","article-title":"Biology and Significance of Alpha-fetoprotein in Hepatocellular Carcinoma","volume":"39","author":"Galle","year":"2019","journal-title":"Liver Int."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1136\/gut.2007.139477","article-title":"Hepatocellular Carcinoma in Budd-Chiari Syndrome: Characteristics and Risk Factors","volume":"57","author":"Moucari","year":"2008","journal-title":"Gut"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s12072-021-10189-4","article-title":"Budd-Chiari Syndrome: Consensus Guidance of the Asian Pacific Association for the Study of the Liver (APASL)","volume":"15","author":"Shukla","year":"2021","journal-title":"Hepatol. Int."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1002\/ags3.12529","article-title":"Update on Perioperative Management of Patients Undergoing Surgery for Liver Cancer","volume":"6","author":"Kaibori","year":"2022","journal-title":"Ann. Gastroenterol. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1102\/1470-7330.2007.0002","article-title":"Imaging of Liver Metastases: MRI","volume":"7","author":"Namasivayam","year":"2007","journal-title":"Cancer Imaging"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"204","DOI":"10.7812\/TPP\/19.204","article-title":"Shalimar Budd Chiari Syndrome and Intrahepatic Cholangiocarcinoma, An Unusual Combination: Case Report and Review of the Literature","volume":"24","author":"Elhence","year":"2020","journal-title":"Perm. J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"bcr2017221103","DOI":"10.1136\/bcr-2017-221103","article-title":"Primary Hepatic Hemangioendothelioma in a Patient with Budd-Chiari Syndrome","volume":"2017","author":"Shah","year":"2017","journal-title":"BMJ Case Rep."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1148\/radiol.2015142576","article-title":"Pitfalls in Liver Imaging","volume":"278","author":"Vilgrain","year":"2016","journal-title":"Radiology"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.clinimag.2021.09.008","article-title":"Unveiling the Unreal: Comprehensive Imaging Review of Hepatic Pseudolesions","volume":"80","author":"Ramanathan","year":"2021","journal-title":"Clin. Imaging"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"160","DOI":"10.2214\/AJR.05.1367","article-title":"Transient Hepatic Intensity Differences: Part 2, Those Not Associated with Focal Lesions","volume":"188","author":"Colagrande","year":"2007","journal-title":"Am. J. Roentgenol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/14\/2346\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:11:11Z","timestamp":1760127071000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/14\/2346"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,12]]},"references-count":52,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["diagnostics13142346"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13142346","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,12]]}}}