Application value of enhanced CT imaging in the diagnosis and treatment of primary hepatic venous Budd-Chiari syndrome

Objective To retrospectively analyze the enhanced CT imaging features of primary hepatic venous Budd-Chiari syndrome (BCS). Methods Patients diagnosed with primary hepatic venous BCS by digital subtraction angiography at Beijing Shijitan Hospital affiliated with Capital Medical University from 2014 to 2024 were included in the study. All patients underwent enhanced CT imaging, and the patterns of liver parenchyma, liver related blood vessels, and other related imaging findings in enhanced CT imaging were observed and analyzed. Clinical manifestations, laboratory tests, and postoperative progression were also analyzed. Results A total of 26 patients with primary hepatic venous BCS were included, including 12 males and 14 females. Enhanced CT imaging showed no significant enhancement or mild enhancement in the arterial phase of liver parenchyma, while the main enhancement modes in the portal venous or delayed phase of liver parenchyma were observed, including 3 cases (11.5%) with uniform enhancement, 3 cases (11.5%) with patchy uneven enhancement, 15 cases (57.7%) with central enhancement, 5 cases (19.2%) local irregular enhancement. A total of 24 patients underwent interventional surgery treatment, and postoperative follow-up CT enhancement showed varying degrees of improvement. Conclusion Enhanced CT imaging of primary hepatic venous BCS has characteristic features such as thickening of portal vein and splenic vein, opening of intrahepatic and collateral circulation, and patchy enhancement of liver specific distribution. Enhanced CT imaging can improve the diagnostic accuracy of primary hepatic venous BCS and provide irreplaceable value in postoperative follow- up.