Original ArticleArterial spin-labeled perfusion for vascular anomalies in the pediatric head and neck☆,☆☆
Section snippets
Background and purpose
Conventional MRI, namely fat-suppressed T2-weighted and gadolinium-enhanced T1-weighted sequences, serves as the cornerstone for diagnosing vascular anomalies [1]. Classic imaging appearances, such as phleboliths in venous malformations or large macrocysts in lymphatic malformations, are highly specific features for these lesions but have variable sensitivity given the frequency of atypical imaging features and combined malformations. For example, differentiating between hemangiomas and venous
Materials and methods
This study was approved by the institutional review board, which waived the requirement for informed consent. Electronic medical records were reviewed for all children (<18 years) with vascular anomalies that underwent ASL MRI over the 5-year period from June 2010 to June 2015. Our investigation focused on lesions within the head and neck; cerebral arteriovenous malformation (AVMs) or dural arteriovenous fistula (AVFs) were excluded. Two neuroradiologists (9 years and 2 years of experience
Results
From the hospital records, 25 patients were identified with cutaneous vascular anomalies (Table 1). There were 8 males and 17 females with ages ranging from 2 days to 14 years (mean, 2.3±3.8 years). Of the 25 patients, 14 had proliferating infantile hemangiomas (3 of these were diagnosed with PHACE syndrome [5]), 2 had involuting infantile hemangiomas (1 of these was diagnosed with PHACE syndrome), 4 had venous malformations, 3 had lymphatic malformations, and there was 1 case each of soft
Discussion
In this study, we have shown that vascular anomalies demonstrate specific signal intensities on ASL imaging depending on the type of anomaly. Proliferating infantile hemangiomas consistently show increased ASL signal, while venous malformations generally show no or mildly increased ASL signal, and lymphatic malformations and involuting infantile hemangiomas lack ASL signal. Increased ASL signal can be seen with AVMs.
To our knowledge, there has been only one mention of ASL imaging for cutaneous
Conclusions
ASL imaging of cutaneous vascular anomalies shows specific signal intensity patterns, depending on the anomaly type, and can provide additional value when compared to conventional MR sequences. Proliferating hemangiomas show increased ASL signal, while venous malformations show either no or mildly increased signal. ASL imaging can increase the conspicuity of certain lesions and can assess alterations in CBF that may be clinically significant and affect patient management.
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