MDCT angiography in evaluation of pediatric hemangiomas and peripheral vascular malformations

Rohini Gupta Ghasi; Varun Narayan; Brij Bhushan Thukral

doi:10.18203/2320-6012.ijrms20184912

Authors

Rohini Gupta Ghasi Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India http://orcid.org/0000-0002-3027-1739
Varun Narayan Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India
Brij Bhushan Thukral Department of Radiodiagnosis, VMMC and Safdarjung Hospital, New Delhi, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20184912

Keywords:

CT angiography, Hemangioma, MDCT, Pediatric, Vascular malformation, Venous malformation

Abstract

Background: To evaluate the role of MDCT angiography in peripheral hemangiomas and vascular malformations in pediatric patients.

Methods: Total of 36 consecutive pediatric patients with clinically suspected peripheral hemangiomas and peripheral malformations were included in the study. MDCT angiography and doppler sonography was done for all patients. Final diagnosis was made by response to treatment and follow up. The statistical significance of various MDCT findings and post processing techniques was calculated. p value of <0.05 was considered significant.

Results: Venous malformations were the most common. The MDCTA features which were significant in diagnosing venous malformations were phleboliths (p=0.039), peak enhancement in venous or delayed phase, absence of soft tissue mass, lacy tangle of vessels on maximum intensity projection and volume rendered images. Features significant in diagnosing arteriovenous malformations were tortuous arterial feeders, peak enhancement in arterial phase (0.0001), early draining vein (p=0.0001), venous phase wash out (p=0.0001), tense tangle of vessels on maximum intensity projection and volume rendered images (p=0.0003). Phleboliths (p=0.43) and venous or delayed phase peak enhancement (p=0.69) were overlapping features in congenital hemangiomas and venous malformations. Arterial phase enhancement (p=0.10) and early draining veins (p=0.39) were overlapping features in infantile proliferating hemangiomas and arteriovenous malformations. However, presence of soft tissue mass (p=0.0001) and lack of venous phase wash out (p=0.0003) were differentiating features for hemangiomas.

Conclusions: MDCT angiography can be used as a highly accurate modality to diagnose hemangiomas and vascular malformations. It has an advantage over color Doppler in depicting entire extent of deep lesions.

Metrics

Metrics Loading ...

References

Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg. 1982 Mar;69(3):412-22.

Legiehn GM, Heran MK. Venous malformations: classification, development, diagnosis, and interventional radiologic management. Radiologic Clinics North America. 2008 May 1;46(3):545-97.

Merrow AC, Gupta A, Patel MN, Adams DM. 2014 revised classification of vascular lesions from the international society for the study of vascular anomalies: radiologic-pathologic update. Radiographics. 2016 Aug 12;36(5):1494-516.

Finn MC, Glowacki J, Mulliken JB. Congenital vascular lesions: clinical application of a new classification. J Pediatric Surg. 1983 Dec 1;18(6):894-900.

Paltiel HJ, Burrows PE, Kozakewich HP, Zurakowski D, Mulliken JB. Soft-tissue vascular anomalies: utility of US for diagnosis. Radiol. 2000 Mar;214(3):747-54. Pediatr Radiol. 2005 Jan 1;35(1):40-53.

Mahesh B, Thulkar S, Joseph G, Khazanchi RK, Shrivastava A. Color duplex ultrasound guided sclerotherapy: a new approach to management of patients with peripheral venous malformations. J Clin Im. 2003;27(3):171-9.

Kakimoto N, Tanimoto K, Nishiyama H, Murakami S, Furukawa S, Kreiborg S. CT and MR imaging features of oral and maxillofacial hemangioma and vascular malformation. Eur J Radiol. 2005 Jul 1;55(1):108-12.

Chan FP, Rubin GD. MDCT angiography of pediatric vascular diseases of the abdomen, pelvis, and extremities. Pediatr Radiol. 2005 Jan 1;35(1):40-53.

Dubois J, Garel L. Imaging and therapeutic approach of hemangiomas and vascular malformations in the pediatric age group. Pediatr Radiol. 1999 Nov 1;29(12):879-93.

Rubin GD, Rofsky NM. CT and MR Angiography: Comprehensive Vascular Assessment. Philadelphia:Lippincott Williams & Wilkins;2009.

Arnold R, Chaudry G. Diagnostic imaging of vascular anomalies. Clin Plastic Surg. 2011 Jan 1;38(1):21-9.

Bittles MA, Sidhu MK, Sze RW, Finn LS, Ghioni V, Perkins JA. Multidetector CT angiography of pediatric vascular malformations and hemangiomas: utility of 3-D reformatting in differential diagnosis. Pediatr Radiol. 2005 Nov 1;35(11):1100-6.

Leng T, Wang X, Huo R, Cheng Z, Feng Y. The value of three-dimensional computed tomographic angiography in the diagnosis and treatment of vascular lesions. Plastic Reconstructive Surg. 2008 Nov 1;122(5):1417-24.

Tao Q, Biao LV, Bhatia KS, Qiao B, Zheng CQ, Chen ZF. Three-dimensional CT angiography for the diagnosis and assessment of arteriovenous malformations in the oral and maxillofacial region. J Cranio-Maxillofacial Surg. 2010 Jan 1;38(1):32-7.