Case-Based Review of Vascular Anomalies
Maliha Sadick1
1Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, 68167 Mannheim, Germany

Synopsis

Introduction:Vascular Malformations represent a rare disease. The most common vascular anomalies include venous (VM), lymphatic (LM), arteriovenous (AVM) and combined malformations (CM).MRI in Slow-Flow and Fast-Flow Vascular Malformations:VMs are hyperintense lesions in Multiplanar Turbo Inversion Recovery Magnitude (TIRM) or T2-weighted TurboSpinEcho (T2 TSE) imaging. In late T1Vibe the full extent and patency of the VM is displayed.LMs appear as hyperintense cysts with/without septation in T2-weighted TSE sequences.AVMS are characterized by flow voids. MR-Time-resolved Angiography With Interleaved Stochastic Trajectories is mandatory for depiction of flow dynamics and shunting.Conclusion:MRI-morphology of vascular malformations decides on treatment.

Introduction: Vascular Malformations represent a rare disease based on genetic disorder of vasculogenesis and angiogenesis. They present at birth and progress with age, causing heterogeneous clinical manifestations and symptoms (1, 2). The most common vascular anomalies according to the ISSVA classification include venous (VM), lymphatic (LM), arteriovenous (AVM) and combined malformations (CM) with an incidence of approx. 70% VMs, 15% LMs, 9% AVMs and 7% CMs (3). They have distinctive flow-dynamics and morphological structures which facilitate MRI diagnosis and delivery of dedicated therapy.
MRI Features of Slow-Flow Vascular Malformations: VMs are hyperintense lesions in Multiplanar Turbo Inversion Recovery Magnitude (TIRM) or T2-weighted TurboSpinEcho (T2 TSE) imaging. In late T1Vibe fs the full extent and patency of the venous system of the affected region is displayed. VMs shows moderate uptake of contrast in patent areas which have not undergone local fibrosis following phlebitis or sclerotherapy. LMs appear as hyperintense cysts with/without septation in T2-weighted TSE sequences with almost no contrast uptake in T1-weighted TSE imaging unless local hemorrhage or inflammation has taken place.
MRI Features of Fast-Flow Vascular Malformations: AVMs never appear as a mass on T1-weighted TSE imaging pre/post contrast. They are characterized by flow voids, representing clusters of dilated arteries and veins feeding a nidus. MR-Time-resolved Angiography With Interleaved Stochastic Trajectories is mandatory for depiction of flow dynamics and shunting. AVMs remain hypointense on T2- and pre contrast T1-weighted images.
Conclusion: Distinction of clinical and MR-morphological features of vascular malformations is a prerequisite for appropriate diagnosis and dedicated treatment.

Acknowledgements

No acknowledgement found.

References

1. Sadick M, Müller-Wille R, Wildgruber M, Wohlgemuth WA (2018): Vascular Anomalies (Part I): Classification and Diagnostics of Vascular Anomalies. Rofo 190: 825-8352.

2. Sadick M, Overhoff D, Baessler B, von Spangenberg N, Krebs L, Wohlgemuth WA (2019): Peripheral Vascular Anomalies – Essentials in Periinterventional Imaging. Rofo 191: 1-133.

3. Wassef M, Blei F, Adams D, Alomari A, Baselga E, Berenstein A, Burrows P, Frieden IJ, Garzon MC, Lopez-Gutierrez LC, Lord DJE, Mitchel S, Powell J, Prendiville J, Vikkula M (2015): Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies. Pediatrics 136, 203-214

Proc. Intl. Soc. Mag. Reson. Med. 30 (2022)