Imaging in Hemangioma and Vascular Malformations

Most superficial and mixed infantile hemangiomas :diagnosed based upon their clinical features.

imaging may be used for defining the extent and depth of the deep component of mixed lesions.

Radiologic evaluation is particularly helpful for confirming the diagnosis of deep infantile hemangiomas that lack superficial changes.

It is important to consider the phase of growth when assessing hemangiomas radiographically

proliferating hemangiomas demonstrate different characteristics than their involuting and involuted counterparts.

Which technique is the most useful for helping to define the extent and tissue characteristics of vascular tumors?

MRI

use of contrast can help to differentiate an infantile hemangioma from other tumors.

If MRI does not confirm the diagnosis of infantile hemangioma or there are concerns regarding a possible malignancy histologic examination of the tumor is recommended.

Look for the presence of hemangiomas within internal organs and to detect other structural anomalies, including CNS malformations and arterial anomalies?

MRI and/or MR angiography(MRA)

Imaging Characteristics of RICH:

can be recognized by prenatal ultrasonography during the second and third trimester

misdiagnosis as other vascular anomalies such as lymphatic or arteriovenous malformations is common

Postnatal ultrasonographic evaluation of a RICH reveals uniformly hypoechoic lesions mostly confined to the subcutaneous fat. Diffuse vascularity is typical, with vessels showing venous or low-resistance arterial flow

NICH Doppler evaluation : fast-flow vessels

MRI: features similar to infantile hemangiomas

Kasabach-Merritt phenomenon

MRI Findings:diffuse soft tissue masses that enhance after contrast administration Ill-defined margins involvement of multiple tissue planes overlying cutaneous thickening edema

Vascular Malformations

>90% of vascular malformations can be correctly categorized on the basis of their clinical features

This helps in the selection of the best investigative tools avoiding redundant and unnecessary diagnostic imaging procedures.

For Lymphatic Malformation:

The Best option is: Sonography (4+) then, MRI with gadolinium (3+)

Capillary malformation

Ultrasound and biopsy are of little help (1+)

No other method is useful (0)

PWS in the V1 or V1 + other sitesExamination:neurologic,ophthalmologicMRI with gadoliniumfavored over CTConsider SPECTor PET scan

Port-wine stain with any bluish hue, bluish mass or swelling in proclive position in the midforhead or cheek

MRI + MRA + CT SCAN:DIAGNOSISASSESS EXTENT AND DEPTH OF INVOLVEMENT

For Venous Malformation:

The Best option is MRI with gadolinium : (4+) then, Sonography (3+) then CT Angio or MRI Angio or CT with contrast

For Arterio-Venous Malformation:

The Best options are Sonography, CT Angio or MRI Angio or arteriography (4+) then, MRI with gadolinium (3+)

Arteriovenous malformation

Final Points: