Evaluation of collateral circulation in Budd-Chiari syndrome with CTA technique using 64-slice CT
LI Xiao-dong1, LV Bao-tao2, ZHANG Yun-ting1
1. Department of Radiology, General Hospital of Tianjin Medical University, Tianjin 300052, China;2. Taishan Medical College, Taian Shandong 271016, China
Abstract：Objective: To evaluate the computed tomographic angiography(CTA) technique in the diagnosis of collateral circulation in Budd-Chiari syndrome(BCS). Methods: Seventy-four patients with mix-type BCS were examined by CTA technique. The involved hepatic veins(HVs), inferior vena cavas(IVCs) and collateral pathways were observed in detail. Results: Obstructions of HVs and IVCs were found in all the 74 patients at different level and degree, collateral pathways developed and were defined in each patient. The collaterals can be classified as intrahepatic, extrahepatic collaterals and portal vein-systemic vein communication. Intrahepatic collaterals were further classified as the following six types: ①hepatic vein(HV)-accessory hepatic vein(AHV) pathway(n=47, 63.5%); ②HV-HV pathway(n=5, 6.7%); ③HV-AHV/HV pathway(n=6, 8.1%); ④inferior vein cava(IVC)-AHV-HV-right atrium pathway(n=4, 5.4%); ⑤HV-umbilical vein pathway(n=4, 5.4%); ⑥HV-hepatic subcapsular vein pathway(n=8, 10.8%). Blood of obstructed HVs was drained into IVC, right atrium, umbilical veins or hepatic subcapsular veins through communicating branches which were in various amount and diameter. Extrahepatic collaterals include: ①ascending lumbar-azygos/hemiazygos pathway(n=74, 100%); ②left renal-ascending lumbar-hemiazygos(n=74, 100%)/left renal-inferior phrenic vein pathway(n=48, 64.8%); ③renal vein-renal subcapsular vein-superficial collaterals of the abdominal wall pathway(n=26, 35.1%); ④superficial abdominal wall pathway(n=10, 13.5%). Conclusion: Collateral circulations of BCS can be demonstrated clearly and non-invasively by CTA. CTA is valuable for the guidance in choosing right therapy method.
2010, Vol. 21 
