Hexagonal Enhancement Pattern on Hepatobiliary Phase MRI: A New Diagnostic Marker for Budd-Chiari Syndrome

Purpose The aim of our study is to identify the hexagonal-shaped specific enhancement pattern observed in the hepatobiliary phase images obtained using hepatocyte-specific contrast agents in patients who developed chronic hepatic parenchymal disease due to Budd-Chiari Syndrome. Methods Our study included 56 patients with chronic parenchymal disease due to Budd-Chiari Syndrome and two control groups comprising 100 patients with chronic parenchymal disease due to other causes. Hepatocyte-specific contrast agents (5–10 ml) were administered during MRI, and late-phase images were obtained at the 20th and 40th minutes. These images were independently evaluated by three radiologists. The presence of specific imaging findings and hepatic venous variations, if any, were recorded in both groups. Results Among the 56 patients with chronic parenchymal disease caused by Budd-Chiari Syndrome, 46 exhibited a hexagonal-shaped focal enhancement pattern. However, this specific finding was not observed in the two control groups, each consisting of 50 patients with chronic liver parenchymal disease of different etiologies. In the target group, 10 patients without the enhancement pattern were found to have an enlarged right inferior hepatic vein. Conclusion The hexagonal-shaped enhancement pattern observed in the 20th and 40th-minute late-phase MRI images using hepatocyte-specific contrast agents appears to be a specific finding for chronic hepatic parenchymal disease due to Budd-Chiari Syndrome.