Which imaging modalities are recommended for the diagnosis of hepatic vein obstruction in suspected Budd-Chiari syndrome?

Imaging modalities recommended for diagnosing hepatic vein obstruction in suspected Budd-Chiari syndrome primarily include Doppler ultrasound as the first-line investigation, followed by cross-sectional imaging such as contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) for further evaluation.

Doppler ultrasound is the initial preferred modality due to its non-invasiveness, accessibility, and ability to assess hepatic vein patency, flow direction, and detect thrombus or obstruction effectively. It can also evaluate collateral venous pathways and liver parenchymal changes associated with Budd-Chiari syndrome ¹ (Chaubal et al., 2006).

When ultrasound findings are inconclusive or to better delineate the extent of hepatic vein and inferior vena cava involvement, contrast-enhanced CT or MRI is recommended. These modalities provide detailed anatomical visualization of hepatic veins, inferior vena cava, and liver parenchyma, and can identify associated focal liver lesions or complications ¹ (Bansal et al., 2018; Rizzetto et al., 2023).

Magnetic resonance venography (MRV) is particularly useful for non-invasive vascular mapping without ionizing radiation and can complement ultrasound findings, especially in complex cases (Bansal et al., 2018).

In summary, the diagnostic pathway integrates Doppler ultrasound as the frontline tool, with CT or MRI reserved for confirmation, detailed assessment, or when ultrasound is insufficient ¹ (Chaubal et al., 2006; Bansal et al., 2018; Rizzetto et al., 2023).