Which imaging to evaluate for "a venous obstruction amenable to percutaneous angioplasty and stenting" in acute or subacute Budd Chiari?

[docren004]

Can any of the following imaging modalities visualize "a venous obstruction amenable to percutaneous angioplasty and stenting" in the hepatic veins and IVC?

• 
  
• US of the abdomen with grayscale, color Doppler, and spectral Doppler technique
  
• MRI of the abdomen, without and with 10 mL IV VUEWAY contrast.
  
• CT of the abdomen and pelvis, with contrast 100 mL IV OMNIPAQUE 350
  

I ask because UpToDate states that, for acute or subacute Budd Chiari syndrome, angioplasty and stending is a reasonable treatment option if "...a venous obstruction amenable to percutaneous angioplasty and stenting is visualized radiologically (eg, on magnetic resonance venography or percutaneous venography)."
Theoretically, would doing another scan in addition to the ones above, such as MRI venography, or even a hepatic protocol MRI using Eovist maybe, add value in terms of answering this question?


To be clear, I am asking this purely as an educational exercise because I am trying to understand and learn more about different kinds of imaging modalities available.

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[clutch21]

All of those studies, provided adequate technique and contrast timing, can evaluate patency of the hepatic veins and IVC.

I personally wouldn’t trust US to make any important treatment decisions. Have seen too many fake outs and artifact on US, even assuming a good US tech.

Both a portal venous phase CT and multiphase MRI though would be reasonable options. I’m sure some fancy institutions have a nice MR venography protocol for this, but just a routine liver protocol MR with an extracellular agent would work fine. Eovist would be inferior for this indication.

 

[NDcienporciento100]

Can any of the following imaging modalities visualize "a venous obstruction amenable to percutaneous angioplasty and stenting" in the hepatic veins and IVC?

• 
  
• US of the abdomen with grayscale, color Doppler, and spectral Doppler technique
• MRI of the abdomen, without and with 10 mL IV VUEWAY contrast.
• CT of the abdomen and pelvis, with contrast 100 mL IV OMNIPAQUE 350

I ask because UpToDate states that, for acute or subacute Budd Chiari syndrome, angioplasty and stending is a reasonable treatment option if "...a venous obstruction amenable to percutaneous angioplasty and stenting is visualized radiologically (eg, on magnetic resonance venography or percutaneous venography)."
Theoretically, would doing another scan in addition to the ones above, such as MRI venography, or even a hepatic protocol MRI using Eovist maybe, add value in terms of answering this question?


To be clear, I am asking this purely as an educational exercise because I am trying to understand and learn more about different kinds of imaging modalities available.

When deciding whether a hepatic vein, thrombosis/or stenosis is amenable to, angioplasty or Stenting or TIPS. The answer is not what image modality will give you that answer. The answer is to call an interventional radiologist. Eovist would be useless. It’s secreted in the bile ducks has nothing to do with the veins. CTV and MRV gives great anatomic detail.