Skip to main content

Advertisement

SpringerLink
Log in

MR imaging characteristics of soft tissue vascular anomalies in children

  • Review
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Accurate classification of soft tissue vascular anomalies is critical since treatment options and morbidity differ significantly for the various groups of vascular anomalies (VA). A classification system introduced by Mulliken and Glowacki in 1982 explained the biology of VA, thus resulting in improved management and communication between different disciplines taking care of children with soft tissue vascular anomalies. This classification has been updated by the International Society for the Study of Vascular Anomalies in 1996 and forms the basis for the current nomenclature. Although the majority of vascular anomalies can be accurately classified by their clinical history and a physical exam, imaging is necessary to determine the full anatomical extent of the anomaly, to follow up treatment response, to confirm diagnosis, and to provide correct classification in challenging cases when necessary. This article will review the key magnetic resonance imaging (MRI) features of most common soft tissue vascular anomalies in children. MRI and dynamic contrast-enhanced magnetic resonance angiography are crucial for the evaluation of vascular anomalies in children because of lack of radiation, high soft tissue resolution, and the capability of dynamic contrast-enhanced images to reflect the hemodynamics of the anomalies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

References

  1. Adams DM (2001) The nonsurgical management of vascular lesions. Facial Plast Surg Clin North Am 9:601–608

    PubMed  CAS  Google Scholar 

  2. Amir J, Metzker A, Krikler R, Reisner SH (1986) Strawberry hemangioma in preterm infants. Pediatr Dermatol 3:331–332

    Article  PubMed  CAS  Google Scholar 

  3. Babilas P, Shafirstein G, Baumler W, Baier J, Landthaler M, Szeimies RM, Abels C (2005) Selective photothermolysis of blood vessels following flashlamp-pumped pulsed dye laser irradiation: in vivo results and mathematical modelling are in agreement. J Invest Dermatol 125:343–352

    PubMed  CAS  Google Scholar 

  4. Bayrak-Toydemir P, McDonald J, Akarsu N, Toydemir RM, Calderon F, Tuncali T, Tang W, Miller F, Mao R (2006) A fourth locus for hereditary hemorrhagic telangiectasia maps to chromosome 7. Am J Med Genet A 140:2155–2162

    PubMed  Google Scholar 

  5. Bruder E, Perez-Atayde AR, Jundt G, Alomari AI, Rischewski J, Fishman SJ, Mulliken JB, Kozakewich HP (2009) Vascular lesions of bone in children, adolescents, and young adults. A clinicopathologic reappraisal and application of the ISSVA classification. Virchows Arch 454:161–179

    Article  PubMed  Google Scholar 

  6. Choi DJ, Alomari AI, Chaudry G, Orbach DB (2009) Neurointerventional management of low-flow vascular malformations of the head and neck. Neuroimaging Clin N Am 19:199–218

    Article  PubMed  Google Scholar 

  7. Christison-Lagay ER, Fishman SJ (2006) Vascular anomalies. Surg Clin North Am 86:393–425, x

    Article  PubMed  Google Scholar 

  8. Claudon M, Upton J, Burrows PE (2001) Diffuse venous malformations of the upper limb: morphologic characterization by MRI and venography. Pediatr Radiol 31:507–514

    Article  PubMed  CAS  Google Scholar 

  9. Cole SG, Begbie ME, Wallace GM, Shovlin CL (2005) A new locus for hereditary haemorrhagic telangiectasia (HHT3) maps to chromosome 5. J Med Genet 42:577–582

    Article  PubMed  CAS  Google Scholar 

  10. Dobson MJ, Hartley RW, Ashleigh R, Watson Y, Hawnaur JM (1997) MR angiography and MR imaging of symptomatic vascular malformations. Clin Radiol 52:595–602

    Article  PubMed  CAS  Google Scholar 

  11. Donnelly LF, Adams DM, Bisset GS 3rd (2000) Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic. AJR Am J Roentgenol 174:597–608

    Article  PubMed  CAS  Google Scholar 

  12. Dubois J, Alison M (2010) Vascular anomalies: what a radiologist needs to know. Pediatr Radiol 40:895–905

    Article  PubMed  Google Scholar 

  13. Duffy K (2010) Genetics and syndromes associated with vascular malformations. Pediatr Clin North Am 57:1111–1120

    Article  PubMed  Google Scholar 

  14. Eerola I, Boon LM, Mulliken JB, Burrows PE, Dompmartin A, Watanabe S, Vanwijck R, Vikkula M (2003) Capillary malformation–arteriovenous malformation, a new clinical and genetic disorder caused by RASA1 mutations. Am J Hum Genet 73:1240–1249

    Article  PubMed  CAS  Google Scholar 

  15. Eifert S, Villavicencio JL, Kao TC, Taute BM, Rich NM (2000) Prevalence of deep venous anomalies in congenital vascular malformations of venous predominance. J Vasc Surg 31:462–471

    Article  PubMed  CAS  Google Scholar 

  16. Enjolras O, Wassef M, Mazoyer E, Frieden IJ, Rieu PN, Drouet L, Taieb A, Stalder JF, Escande JP (1997) Infants with Kasabach–Merritt syndrome do not have “true” hemangiomas. J Pediatr 130:631–640

    Article  PubMed  CAS  Google Scholar 

  17. Fayad LM, Hazirolan T, Bluemke D, Mitchell S (2006) Vascular malformations in the extremities: emphasis on MR imaging features that guide treatment options. Skeletal Radiol 35:127–137

    Article  PubMed  Google Scholar 

  18. Fayad LM, Hazirolan T, Carrino JA, Bluemke DA, Mitchell S (2008) Venous malformations: MR imaging features that predict skin burns after percutaneous alcohol embolization procedures. Skeletal Radiol 37:895–901

    Article  PubMed  Google Scholar 

  19. Gorincour G, Kokta V, Rypens F, Garel L, Powell J, Dubois J (2005) Imaging characteristics of two subtypes of congenital hemangiomas: rapidly involuting congenital hemangiomas and non-involuting congenital hemangiomas. Pediatr Radiol 35:1178–1185

    Article  PubMed  Google Scholar 

  20. Hein KD, Mulliken JB, Kozakewich HP, Upton J, Burrows PE (2002) Venous malformations of skeletal muscle. Plast Reconstr Surg 110:1625–1635

    Article  PubMed  Google Scholar 

  21. Hochman M, Adams DM, Reeves TD (2011) Current knowledge and management of vascular anomalies: I. Hemangiomas. Arch Facial Plast Surg 13:145–151

    Article  PubMed  Google Scholar 

  22. Hochman M, Adams DM, Reeves TD (2011) Current knowledge and management of vascular anomalies: II. Malformations. Arch Facial Plast Surg 13:425–433

    Article  PubMed  Google Scholar 

  23. Konez O, Burrows PE (2002) Magnetic resonance of vascular anomalies. Magn Reson Imaging Clin N Am 10:363–388, vii

    Article  PubMed  Google Scholar 

  24. Laor T, Burrows PE, Hoffer FA (1996) Magnetic resonance venography of congenital vascular malformations of the extremities. Pediatr Radiol 26:371–380

    Article  PubMed  CAS  Google Scholar 

  25. Legiehn GM, Heran MK (2008) Venous malformations: classification, development, diagnosis, and interventional radiologic management. Radiol Clin North Am 46:545–597, vi

    Article  PubMed  Google Scholar 

  26. Limaye N, Wouters V, Uebelhoer M, Tuominen M, Wirkkala R, Mulliken JB, Eklund L, Boon LM, Vikkula M (2009) Somatic mutations in angiopoietin receptor gene TEK cause solitary and multiple sporadic venous malformations. Nat Genet 41:118–124

    Article  PubMed  CAS  Google Scholar 

  27. Moukaddam H, Pollak J, Haims AH (2009) MRI characteristics and classification of peripheral vascular malformations and tumors. Skeletal Radiol 38:535–547

    Article  PubMed  Google Scholar 

  28. Mulliken JB, Glowacki J (1982) Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 69:412–422

    Article  PubMed  CAS  Google Scholar 

  29. North PE, Waner M, Mizeracki A, Mihm MC Jr (2000) GLUT1: a newly discovered immunohistochemical marker for juvenile hemangiomas. Hum Pathol 31:11–22

    Article  PubMed  CAS  Google Scholar 

  30. North PE, Waner M, Mizeracki A, Mrak RE, Nicholas R, Kincannon J, Suen JY, Mihm MC Jr (2001) A unique microvascular phenotype shared by juvenile hemangiomas and human placenta. Arch Dermatol 137:559–570

    PubMed  CAS  Google Scholar 

  31. Oduber CE, van der Horst CM, Hennekam RC (2008) Klippel–Trenaunay syndrome: diagnostic criteria and hypothesis on etiology. Ann Plast Surg 60:217–223

    Article  PubMed  CAS  Google Scholar 

  32. Orloff MS, Eng C (2008) Genetic and phenotypic heterogeneity in the PTEN hamartoma tumour syndrome. Oncogene 27:5387–5397

    Article  PubMed  CAS  Google Scholar 

  33. Shen W, Cui J, Chen J, Zou J, Ji Y, Chen H (2010) Kasabach–Merritt syndrome with partial resection of tumor, reduction of tumor blood, and vincristine chemotherapy. J Craniofac Surg 21:215–216

    Article  PubMed  Google Scholar 

  34. Sidbury R (2010) Update on vascular tumors of infancy. Curr Opin Pediatr 22:432–437

    Article  PubMed  Google Scholar 

  35. Siegel MJ (2001) Magnetic resonance imaging of musculoskeletal soft tissue masses. Radiol Clin North Am 39:701–720

    Article  PubMed  CAS  Google Scholar 

  36. Wu IC, Orbach DB (2009) Neurointerventional management of high-flow vascular malformations of the head and neck. Neuroimaging Clin N Am 19:219–240

    Article  PubMed  Google Scholar 

  37. Ziyeh S, Strecker R, Berlis A, Weber J, Klisch J, Mader I (2005) Dynamic 3D MR angiography of intra- and extracranial vascular malformations at 3 T: a technical note. AJNR Am J Neuroradiol 26:630–634

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Yale University-Bridgeport Hospital, Bridgeport, CT, 06610, USA

    Shrey K. Thawait

  2. Department of Dermatology, Johns Hopkins Hospital, Baltimore, MD, 21287, USA

    Kate Puttgen

  3. Division of Musculoskeletal Imaging, Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, 21287, USA

    John A. Carrino & Laura M. Fayad

  4. Division of Interventional Radiology, Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD, 21287, USA

    Sally E. Mitchell

  5. Division of Pediatric Radiology, Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 North Wolfe Street, Nelson Basement, B-172, Baltimore, MD, 21287-0842, USA

    Thierry A. G. M. Huisman & Aylin Tekes

Authors
  1. Shrey K. Thawait
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kate Puttgen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John A. Carrino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura M. Fayad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sally E. Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thierry A. G. M. Huisman
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Aylin Tekes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aylin Tekes.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thawait, S.K., Puttgen, K., Carrino, J.A. et al. MR imaging characteristics of soft tissue vascular anomalies in children. Eur J Pediatr 172, 591–600 (2013). https://doi.org/10.1007/s00431-012-1828-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-012-1828-z

Keywords

Search

Navigation