AIM:To evaluate the role of three-dimensional contrast-enhanced magnetic resonance angiography (3D CE MRA) inthe diagnosis of Budd-Chiari syndrome (BCS).METHODS:Twenty-three patients with BCS underwent3D CE MRA examination,in which 13 cases were secondaryto either hepatocellular carcinoma (11 cases),right adrenalcarcinoma (1 case) or thrombophlebitis (1 case) and 10suffered from primary BCS.The patency of the inferiorvena cava (IVC),hepatic and portal veins as well as thepresence of intra- and extrahepatic collaterals,liverparenchymal abnormalities and porto-systemic variceswere evaluated.Inferior vena cavography was performedin 10 cases.The diagnosis of IVC obstruction by 3D CEMRA was compared with that demonstrated by inferior venacavography.RESULTS:The major features of BCS could be clearlydisplayed on 3D CE MRA.Positive hepatic venous signsincluded tumor thrombosis (9 cases),tumor compression(2 cases),nonvisualization (4 cases) and focal stenosis(2 cases).Positive IVC findings were noted as severe stenosisor occlusion (10 cases),tumor invasion (2 cases),thrombosis(3 cases),thrombophlebitis (1 case) and septum formation(3 cases).Intrahepatic collaterals were shown in 9 patients,2 of them with “spider web” sign.The displayed extrahepaticcollaterals included dilated azygos and hemi-azygos veins(13 cases) and left renal-inferior phrenic-pericardiophrenicveins (2 cases).The occlusion of the left intrahepatic portalveins was found in 2 cases.Porto-systemic varices weredetected in 10 patients.Liver parenchymal abnormalitiesdisplayed by 3D CE MRA were enlargement of the caudatelobe (7 cases),heterogenous enhancement (18 cases) andcomplicated tumors (13 cases).Compared with the inferiorvena cavography performed in 10 cases,the accuracy of 3DCE MRA was 100% in the diagnosis of IVC obstruction.CONCLUSION:3D CE MRA can display the major featuresof BCS and provide an accurate diagnosis. AIM: To evaluate the role of three-dimensional contrast-enhanced magnetic resonance angiography (3D CE MRA) inthe diagnosis of Budd-Chiari syndrome (BCS) .METHODS: Twenty-three patients with BCS underwent3D CE MRA examination, in which 13 cases were secondaryto either hepatocellular carcinoma (11 cases), right adrenalcarcinoma (1 case) or thrombophlebitis (1 case) and 10suffered from primary BCS.The patency of the inferiorvena cava (IVC), hepatic and portal veins as well as thepresence of intra- and extrahepatic collaterals, liverparenchymal abnormalities and porto-systemic variceswere evaluated.Inferior vena cavography was performed in 10 cases. The diagnosis of IVC obstruction by 3D CEMRA was compared with demonstrated by inferior venacavography .RESULTS: The major features of BCS could be clearly displayed on 3D CE MRA .Positive hepatic venous signsincluded tumor thrombosis (9 cases), tumor compression (2 cases), nonvisualization (4 cases) and focal stenosis (2 cases) .Positive IVC findings were noted as severe stenosisor occlusion (10 cases), tumor invasion (2 cases), thrombosis (3 cases), thrombophlebitis (1 case) and septum formation (3 cases) .Intrahepatic collaterals were shown in 9 patients, 2 of them with “ spider web ”. The displayed extrahepatic collaterals included dilated azygos and hemi-azygos veins (13 cases) and left renal-inferior phrenic-pericardiophrenicveins (2 cases). The occlusion of the left intrahepatic portalveins was found in 2 cases. Porto-systemic varices weredetected in 10 patients. Liver parenchymal abnormalities displayed by 3D CE MRA were enlargedment of the caudatelobe (7 cases), heterogenous enhancement (18 cases) andcomplicated tumors (13 cases) .Compared with the inferior vena cavography performed in 10 cases, the accuracy of 3DCE MRA was 100% in the diagnosis of IVC obstruction. CONCLUSION: 3D CE MRA can display the major features of BCS and provide an accurate diagnosis.