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AJNR - American Journal of Neuroradiology

Published ahead of print on January 25, 2008
doi: 10.3174/ajnr.A0937

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American Journal of Neuroradiology 29:807-813, April 2008
© 2008 American Society of Neuroradiology

PEDIATRICS

PHACES Association: A Neuroradiologic Review of 17 Patients

V.S. Oza^a, E. Wang^b, A. Berenstein^e,f, M. Waner^e,f, D. Lefton^e,f, J. Wells^d and F. Blei^a,c

^a Department of Pediatrics, New York University School of Medicine, New York, NY
^b Department of Radiology, New York University School of Medicine, New York, NY
^c Department of Surgery (Plastic), New York University School of Medicine, New York, NY
^d Department of Neurology, New York University School of Medicine, New York, NY
^e Vascular and Birthmarks Institute of New York, Roosevelt Hospital, New York, NY
^f Albert Einstein School of Medicine, Yeshiva University, New York, NY

Please address correspondence to Francine Blei, MD, Stephen D. Hassenfeld Center for Children with Cancer and Blood Disorders of NYU Medical Center, 160 East 32nd St, 2nd Floor, L3-Medical, New York, NY 10016; e-mail: francine.blei{at}nyumc.org

BACKGROUND AND PURPOSE: We present neuroradiologic findings in 17 patients with posterior fossa malformations, hemangiomas, arterial anomalies, cardiac defects, eye abnormalities, and sternal or ventral defects (PHACES) association and identify those at highest risk of central nervous system (CNS) structural, cerebrovascular, and neurodevelopmental abnormalities.

Materials and METHODS: Patients with PHACES association were identified in the Vascular Anomalies Program at New York University Medical Center from 1998 to 2007. Many patients were followed in conjunction with other specialists at the Birthmark Institute at Roosevelt Hospital. Clinical records and imaging studies were reviewed retrospectively. Criteria for diagnosis of PHACES were based on previously published indicators. Imaging studies were independently re-reviewed by a neuroradiologist. Segmental mapping of cutaneous hemangioma distribution by photograph review and presence or absence of other PHACES-associated findings were correlated with radiologic findings.

RESULTS: Patients with large facial cutaneous (S1-S4) hemangiomas were especially at risk of CNS structural and cerebrovascular anomalies; S1 with ocular anomalies; and S3 with airway, ventral, and cardiac anomalies. All patients with CNS structural malformations had a cerebrovascular abnormality, and this cohort was at risk for developmental and/or other neurologic sequelae. Four patients had supratentorial CNS anomalies, including cortical dysgenesis and migration abnormalities. Some patients with CNS arteriopathy progressed to aneurysms.

CONCLUSION: Our data support and expand the work of others, identifying risk factors for segmental hemangiomas. In addition to posterior fossa CNS anomalies, supratentorial anomalies may be present in patients with PHACES, and this may correlate with significant clinical sequelae. The long-term prognosis of these patients remains unknown.