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 sites Examination: neurologic, ophthalmologic MRI with gadolinium favored over CT Consider SPECT or 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: DIAGNOSIS ASSESS 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: