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Vascular anomalies: what a radiologist needs to know

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Abstract

Most haemangiomas and vascular malformations are identified according to clinical criteria. A good knowledge of the classification and clinical characteristics of the vascular anomalies is necessary when managing these patients. However, some cases are challenging either because of an atypical presentation (e.g., soft-tissue mass with normal overlying skin) or because of classification difficulties. Doppler US and MRI are the two main imaging modalities that allow classification of the vascular anomalies and are useful in those clinically uncertain cases to establish the correct diagnosis. This aids the choice of the most appropriate treatment and to inform the parents of the prognosis. High-resolution grey-scale and Doppler US allow excellent visualization of most superficial masses. Doppler US is the easiest way to assess the haemodynamics of a vascular lesion and to clarify a doubtful diagnosis between a haemangioma and vascular malformation. MRI is the best technique for evaluating the extent of the lesions and their relationship to adjacent structures. While newly developed drugs from angiogenesis research labs are awaited, radiologists have an important role in the treatment of haemangiomas and vascular malformations. Intervention remains crucial in cases of alarming haemangiomas and venous malformations (VM), lymphatic malformations (LM) and arteriovenous malformations (AVM). A multidisciplinary team, including paediatricians, haematologists, surgeons and radiologists, must manage the problem cases both in terms of diagnostic work-up and therapeutic options. This paper will briefly discuss the imaging findings and treatment of vascular anomalies.

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References

  1. Mulliken JB, Glowacki J (1982) Classification of pediatric vascular lesions. Plast Reconstr Surg 70:120–121

    Article  CAS  PubMed  Google Scholar 

  2. Mulliken JB, Fishman SJ, Burrows PE (2000) Vascular anomalies. Curr Probl Surg 37:517–584

    Article  CAS  PubMed  Google Scholar 

  3. Dubois J, Patriquin HB, Garel L et al (1998) Soft-tissue hemangiomas in infants and children: diagnosis using Doppler sonography. AJR 171:247–252

    CAS  PubMed  Google Scholar 

  4. Konez O, Burrows PE (2002) Magnetic resonance of vascular anomalies. Magn Reson Imaging Clin N Am 10:363–388

    Article  PubMed  Google Scholar 

  5. Metry DW, Hawrot A, Altman C et al (2004) Association of solitary, segmental hemangiomas of the skin with visceral hemangiomatosis. Arch Dermatol 140:591–596

    Article  PubMed  Google Scholar 

  6. Metry DW, Dowd CF, Barkovich AJ et al (2001) The many faces of PHACE syndrome. J Pediatr 139:117–123

    Article  CAS  PubMed  Google Scholar 

  7. Léauté-Labrèze C, Taïeb A (2008) Efficacy of beta-blockers in infantile capillary haemangiomas: the physiopathological significance and therapeutic consequences. Ann Dermatol Venereol 135:860–862

    Article  PubMed  Google Scholar 

  8. Boon LM, Enjolras O, Mulliken JB (1996) Congenital hemangioma: evidence of accelerated involution. J Pediatr 128:329–335

    Article  CAS  PubMed  Google Scholar 

  9. North PE, Waner M, James CA et al (2001) Congenital nonprogressive hemangioma: a distinct clinicopathologic entity unlike infantile hemangioma. Arch Dermatol 137:1607–1620

    CAS  PubMed  Google Scholar 

  10. Dubois J, Garel L, David M et al (2002) Vascular soft-tissue tumors in infancy: distinguishing features on Doppler sonography. AJR 178:1541–1545

    PubMed  Google Scholar 

  11. Robertson RL, Robson CD, Barnes PD et al (1999) Head and neck vascular anomalies of childhood. Neuroimaging Clin N Am 9:115–132

    CAS  PubMed  Google Scholar 

  12. Trop I, Dubois J, Guibaud L et al (1999) Soft-tissue venous malformations in pediatric and young adult patients: diagnosis with Doppler US. Radiology 212:841–845

    CAS  PubMed  Google Scholar 

  13. Paltiel HJ, Burrows PE, Kozakewich HP et al (2000) Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology 214:747–754

    CAS  PubMed  Google Scholar 

  14. Siegel MJ (2001) Magnetic resonance imaging of musculoskeletal soft tissue masses. Radiol Clin North Am 39:701–720

    Article  CAS  PubMed  Google Scholar 

  15. Li W, David V, Kaplan R et al (1998) Three-dimensional low dose gadolinium-enhanced peripheral MR venography. J Magn Reson Imaging 8:630–633

    Article  CAS  PubMed  Google Scholar 

  16. Dubois J, Garel L, Abela A et al (1997) Lymphangiomas in children: percutaneous sclerotherapy with an alcoholic solution of zein. Radiology 204:651–654

    CAS  PubMed  Google Scholar 

  17. Molitch HI, Unger EC, Witte CL et al (1995) Percutaneous sclerotherapy of lymphangiomas. Radiology 194:343–347

    CAS  PubMed  Google Scholar 

  18. Ogita S, Tsuto T, Nakamura K et al (1994) OK-432 therapy in 64 patients with lymphangioma. J Pediatr Surg 29:784–785

    Article  CAS  PubMed  Google Scholar 

  19. Baskin D, Tander B, Bankaoğlu M (2005) Local bleomycin injection in the treatment of lymphangioma. Eur J Pediatr Surg 15:383–386

    Article  CAS  PubMed  Google Scholar 

  20. Muir T, Kirsten M, Fourie P et al (2004) Intralesional bleomycin injection (IBI) treatment for haemangiomas and congenital vascular malformations. Pediatr Surg Int 19:766–773

    Article  CAS  PubMed  Google Scholar 

  21. Orford J, Barker A, Thonell S et al (1995) Bleomycin therapy for cystic hygroma. J Pediatr Surg 30:1282–1287

    Article  CAS  PubMed  Google Scholar 

  22. Zhong PQ, Zhi FX, Li R et al (1998) Long-term results of intratumorous bleomycin-A5 injection for head and neck lymphangioma. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 86:139–144

    Article  CAS  PubMed  Google Scholar 

  23. Zulfiqar MA, Zaleha AM, Zakaria Z et al (1999) The treatment of neck lymphangioma with intralesional injection of bleomycin. Med J Malaysia 54:478–481

    CAS  PubMed  Google Scholar 

  24. Sanlialp I, Karnak I, Tanyel FC et al (2003) Sclerotherapy for lymphangioma in children. Int J Pediatr Otorhinolaryngol 67:795–800

    Article  CAS  PubMed  Google Scholar 

  25. Sung MW, Lee DW, Kim DY et al (2001) Sclerotherapy with picibanil (OK-432) for congenital lymphatic malformation in the head and neck. Laryngoscope 111:1430–1433

    Article  CAS  PubMed  Google Scholar 

  26. Alqahtani A, Nguyen LT, Flageole H et al (1999) 25 years’ experience with lymphangiomas in children. J Pediatr Surg 34:1164–1168

    Article  CAS  PubMed  Google Scholar 

  27. Enjolras O, Riche MC, Merland JJ (1985) Facial port-wine stains and Sturge-Weber syndrome. Pediatrics 76:48–51

    CAS  PubMed  Google Scholar 

  28. Jacob AG, Driscoll DJ, Shaughnessy WJ et al (1998) Klippel-Trénaunay syndrome: spectrum and management. Mayo Clin Proc 73:28–36

    Article  CAS  PubMed  Google Scholar 

  29. Gloviczki P, Driscoll DJ (2007) Klippel-Trenaunay syndrome: current management. Phlebology 22:291–298

    Article  CAS  PubMed  Google Scholar 

  30. Cohen MM Jr (2000) Klippel-Trenaunay syndrome. Am J Med Genet 93:171–175

    Article  PubMed  Google Scholar 

  31. Moodley M, Ramdial P (1993) Blue rubber bleb nevus syndrome: case report and review of the literature. Pediatrics 92:160–162

    CAS  PubMed  Google Scholar 

  32. Fretzin DF, Potter B (1965) Blue rubber bleb nevus. Arch Intern Med 116:924–929

    Article  CAS  PubMed  Google Scholar 

  33. Esterly NB (1996) Cutaneous hemangiomas, vascular stains and malformations, and associated syndromes. Curr Probl Pediatr 26:3–39

    Article  CAS  PubMed  Google Scholar 

  34. Wiedemann HR, Burgio GR (1986) Encephalocraniocutaneous lipomatosis and Proteus syndrome. Am J Med Genet 25:403–404

    Article  CAS  PubMed  Google Scholar 

  35. Clark RD, Donnai D, Rogers J et al (1987) Proteus syndrome: an expanded phenotype. Am J Med Genet 27:99–117

    Article  CAS  PubMed  Google Scholar 

  36. Samlaska CP, Levin SW, James WD et al (1989) Proteus syndrome. Arch Dermatol 125:1109–1114

    Article  CAS  PubMed  Google Scholar 

  37. Darmstadt GL, Lane AT (1994) Proteus syndrome. Pediatr Dermatol 11:222–226

    Article  CAS  PubMed  Google Scholar 

  38. Garzon MC, Huang JT, Enjolras O et al (2007) Vascular malformations. Part II: associated syndromes. J Am Acad Dermatol 56:541–564

    Article  PubMed  Google Scholar 

  39. Hovius SE, Borg DH, Paans PR et al (1996) The diagnostic value of magnetic resonance imaging in combination with angiography in patients with vascular malformations: a prospective study. Ann Plast Surg 37:278–285

    Article  CAS  PubMed  Google Scholar 

  40. Taschner CA, Gieseke J, Le Thuc V et al (2008) Intracranial arteriovenous malformation: time-resolved contrast-enhanced MR angiography with combination of parallel imaging, keyhole acquisition, and k-space sampling techniques at 1.5 T. Radiology 246:871–879

    Article  PubMed  Google Scholar 

  41. Reinacher PC, Stracke P, Reinges MH et al (2007) Contrast-enhanced time-resolved 3-D MRA: applications in neurosurgery and interventional neuroradiology. Neuroradiology 49:S3–S13

    Article  PubMed  Google Scholar 

  42. Saleh RS, Lohan DG, Villablanca JP et al (2008) Assessment of craniospinal arteriovenous malformations at 3 T with highly temporally and highly spatially resolved contrast-enhanced MR angiography. AJNR 29:1024–1031

    Article  CAS  PubMed  Google Scholar 

  43. Wu Y, Kim N, Korosec FR et al (2007) 3D time-resolved contrast-enhanced cerebrovascular MR angiography with subsecond frame update times using radial k-space trajectories and highly constrained projection reconstruction. AJNR 28:2001–2004

    Article  CAS  PubMed  Google Scholar 

  44. Ziyeh S, Strecker R, Berlis A et al (2005) Dynamic 3D MR angiography of intra- and extracranial vascular malformations at 3 T: a technical note. AJNR 26:630–634

    CAS  PubMed  Google Scholar 

  45. Enjolras O (1997) Classification and management of the various superficial vascular anomalies: hemangiomas and vascular malformations. J Dermatol 24:701–710

    CAS  PubMed  Google Scholar 

  46. Guttmacher AE, Marchuk DA, White RI Jr (1995) Hereditary hemorrhagic telangiectasia. N Engl J Med 333:918–924

    Article  CAS  PubMed  Google Scholar 

  47. Jessen RT, Thompson S, Smith EB (1977) Cobb syndrome. Arch Dermatol 113:1587–1590

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medical Imaging, Sainte-Justine Hospital, 3175 Cote Ste-Catherine, Montreal, QC, H3T 1C5, Canada

    Josée Dubois & Marianne Alison

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  1. Josée Dubois
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  2. Marianne Alison
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Correspondence to Josée Dubois.

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Dubois, J., Alison, M. Vascular anomalies: what a radiologist needs to know. Pediatr Radiol 40, 895–905 (2010). https://doi.org/10.1007/s00247-010-1621-y

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  • DOI: https://doi.org/10.1007/s00247-010-1621-y

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