Radiographic Findings Associated with Vascular Anomalies

 

 Buy Article Permissions and Reprints

Abstract

Imaging of patients with vascular tumors and malformations has been sufficiently refined to answer pertinent questions when making treatment decisions in this challenging subgroup of pediatric patients. The imaging modalities at hand include conventional radiography, Doppler ultrasound, and magnetic resonance imaging with time-resolved, contrast-material enhanced magnetic resonance angiography. This review article will focus on the characteristic imaging features of some focal and diffuse vascular lesions, which have been classified by their clinical history and physical exam, and further labeled as a vascular tumor or slow-flow versus high-flow vascular malformation based on the updated classification system proposed by the International Society for the Study of Vascular Anomalies. The recent advances in knowledge regarding the biology of these vascular anomalies have led to increased awareness of the current nomenclature. Moreover, with better understanding of the imaging features, the radiologist has become a key player in the multidisciplinary approach offered at various institutions where appropriate treatment algorithms and interventional strategies are put together. This is crucial in avoiding misdiagnosis and improper management.

• References

• 1 Lowe LH, Marchant TC, Rivard DC, Scherbel AJ. Vascular malformations: classification and terminology the radiologist needs to know. Semin Roentgenol 2012; 47 (2) 106-117
  CrossrefPubMedGoogle Scholar
• 2 Kollipara R, Dinneen L, Rentas KE , et al. Current classification and terminology of pediatric vascular anomalies. AJR Am J Roentgenol 2013; 201 (5) 1124-1135
  CrossrefPubMedGoogle Scholar
• 3 Paltiel HJ, Burrows PE, Kozakewich HP, Zurakowski D, Mulliken JB. Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology 2000; 214 (3) 747-754
  CrossrefPubMedGoogle Scholar
• 4 van Rijswijk CS, van der Linden E, van der Woude HJ, van Baalen JM, Bloem JL. Value of dynamic contrast-enhanced MR imaging in diagnosing and classifying peripheral vascular malformations. AJR Am J Roentgenol 2002; 178 (5) 1181-1187
  CrossrefPubMedGoogle Scholar
• 5 Restrepo R, Palani R, Cervantes LF, Duarte AM, Amjad I, Altman NR. Hemangiomas revisited: the useful, the unusual and the new. Part 2: endangering hemangiomas and treatment. Pediatr Radiol 2011; 41 (7) 905-915
  CrossrefPubMedGoogle Scholar
• 6 Flors L, Leiva-Salinas C, Maged IM , et al. MR imaging of soft-tissue vascular malformations: diagnosis, classification, and therapy follow-up. Radiographics 2011; 31 (5) 1321-1340 , discussion 1340–1341
  CrossrefPubMedGoogle Scholar
• 7 Konez O, Burrows PE. Magnetic resonance of vascular anomalies. Magn Reson Imaging Clin N Am 2002; 10 (2) 363-388, vii vii
  CrossrefPubMedGoogle Scholar
• 8 Gorincour G, Kokta V, Rypens F, Garel L, Powell J, Dubois J. Imaging characteristics of two subtypes of congenital hemangiomas: rapidly involuting congenital hemangiomas and non-involuting congenital hemangiomas. Pediatr Radiol 2005; 35 (12) 1178-1185
  CrossrefPubMedGoogle Scholar
• 9 Mulliken JB, Enjolras O. Congenital hemangiomas and infantile hemangioma: missing links. J Am Acad Dermatol 2004; 50 (6) 875-882
  CrossrefPubMedGoogle Scholar
• 10 Burrows PE, Mulliken JB, Fellows KE, Strand RD. Childhood hemangiomas and vascular malformations: angiographic differentiation. AJR Am J Roentgenol 1983; 141 (3) 483-488
  CrossrefPubMedGoogle Scholar
• 11 Burrows PE. Hemangiomas and vascular malformations. Can Assoc Radiol J 1995; 46 (2) 143
  PubMedGoogle Scholar
• 12 Fishman SJ, Mulliken JB. Hemangiomas and vascular malformations of infancy and childhood. Pediatr Clin North Am 1993; 40 (6) 1177-1200
  PubMedGoogle Scholar
• 13 Berenguer B, Mulliken JB, Enjolras O , et al. Rapidly involuting congenital hemangioma: clinical and histopathologic features. Pediatr Dev Pathol 2003; 6 (6) 495-510
  CrossrefPubMedGoogle Scholar
• 14 Restrepo R. Multimodality imaging of vascular anomalies. Pediatr Radiol 2013; 43 (Suppl. 01) S141-S154
  CrossrefPubMedGoogle Scholar
• 15 Meyer JS, Hoffer FA, Barnes PD, Mulliken JB. Biological classification of soft-tissue vascular anomalies: MR correlation. AJR Am J Roentgenol 1991; 157 (3) 559-564
  CrossrefPubMedGoogle Scholar
• 16 Kollipara R, Odhav A, Rentas KE, Rivard DC, Lowe LH, Dinneen L. Vascular anomalies in pediatric patients: updated classification, imaging, and therapy. Radiol Clin North Am 2013; 51 (4) 659-672
  CrossrefPubMedGoogle Scholar
• 17 Chiller KG, Passaro D, Frieden IJ. Hemangiomas of infancy: clinical characteristics, morphologic subtypes, and their relationship to race, ethnicity, and sex. Arch Dermatol 2002; 138 (12) 1567-1576
  CrossrefPubMedGoogle Scholar
• 18 Haggstrom AN, Drolet BA, Baselga E , et al; Hemangioma Investigator Group. Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr 2007; 150 (3) 291-294
  CrossrefPubMedGoogle Scholar
• 19 Dubois J, Alison M. Vascular anomalies: what a radiologist needs to know. Pediatr Radiol 2010; 40 (6) 895-905
  CrossrefPubMedGoogle Scholar
• 20 Jarrett DY, Ali M, Chaudry G. Imaging of vascular anomalies. Dermatol Clin 2013; 31 (2) 251-266
  PubMedGoogle Scholar
• 21 Croteau SE, Liang MG, Kozakewich HP , et al. Kaposiform hemangioendothelioma: atypical features and risks of Kasabach-Merritt phenomenon in 107 referrals. J Pediatr 2013; 162 (1) 142-147
  CrossrefPubMedGoogle Scholar
• 22 Sarkar M, Mulliken JB, Kozakewich HP, Robertson RL, Burrows PE. Thrombocytopenic coagulopathy (Kasabach-Merritt phenomenon) is associated with Kaposiform hemangioendothelioma and not with common infantile hemangioma. Plast Reconstr Surg 1997; 100 (6) 1377-1386
  CrossrefPubMedGoogle Scholar
• 23 Deyrup AT, Miettinen M, North PE , et al. Angiosarcomas arising in the viscera and soft tissue of children and young adults: a clinicopathologic study of 15 cases. Am J Surg Pathol 2009; 33 (2) 264-269
  CrossrefPubMedGoogle Scholar
• 24 Finn MC, Glowacki J, Mulliken JB. Congenital vascular lesions: clinical application of a new classification. J Pediatr Surg 1983; 18 (6) 894-900
  CrossrefPubMedGoogle Scholar
• 25 Mulliken JB, Glowacki J. Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics. Plast Reconstr Surg 1982; 69 (3) 412-422
  CrossrefPubMedGoogle Scholar
• 26 Legiehn GM, Heran MK. Venous malformations: classification, development, diagnosis, and interventional radiologic management. Radiol Clin North Am 2008; 46 (3) 545-597, vi vi
  CrossrefPubMedGoogle Scholar
• 27 Bruder E, Perez-Atayde AR, Jundt G , et al. Vascular lesions of bone in children, adolescents, and young adults. A clinicopathologic reappraisal and application of the ISSVA classification. Virchows Arch 2009; 454 (2) 161-179
  CrossrefPubMedGoogle Scholar
• 28 Marler JJ, Mulliken JB. Vascular anomalies: classification, diagnosis, and natural history. Facial Plast Surg Clin North Am 2001; 9 (4) 495-504
  PubMedGoogle Scholar
• 29 Cahill AM, Nijs E, Ballah D , et al. Percutaneous sclerotherapy in neonatal and infant head and neck lymphatic malformations: a single center experience. J Pediatr Surg 2011; 46 (11) 2083-2095
  CrossrefPubMedGoogle Scholar
• 30 Boardman SJ, Cochrane LA, Roebuck D, Elliott MJ, Hartley BE. Multimodality treatment of pediatric lymphatic malformations of the head and neck using surgery and sclerotherapy. Arch Otolaryngol Head Neck Surg 2010; 136 (3) 270-276
  CrossrefPubMedGoogle Scholar
• 31 Boon LM, Mulliken JB, Enjolras O, Vikkula M. Glomuvenous malformation (glomangioma) and venous malformation: distinct clinicopathologic and genetic entities. Arch Dermatol 2004; 140 (8) 971-976
  CrossrefPubMedGoogle Scholar
• 32 Mulliken JB, Fishman SJ, Burrows PE. Vascular anomalies. Curr Probl Surg 2000; 37 (8) 517-584
  CrossrefPubMedGoogle Scholar
• 33 Moukaddam H, Pollak J, Haims AH. MRI characteristics and classification of peripheral vascular malformations and tumors. Skeletal Radiol 2009; 38 (6) 535-547
  CrossrefPubMedGoogle Scholar
• 34 Burrows PE, Mulliken JB, Fishman SJ, Klement GL, Folkman J. Pharmacological treatment of a diffuse arteriovenous malformation of the upper extremity in a child. J Craniofac Surg 2009; 20 (Suppl. 01) 597-602
  CrossrefPubMedGoogle Scholar
• 35 Donnelly LF, Adams DM, Bisset III GS. Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic. AJR Am J Roentgenol 2000; 174 (3) 597-608
  CrossrefPubMedGoogle Scholar
• 36 El-Merhi F, Garg D, Cura M, Ghaith O. Peripheral vascular tumors and vascular malformations: imaging (magnetic resonance imaging and conventional angiography), pathologic correlation and treatment options. Int J Cardiovasc Imaging 2013; 29 (2) 379-393
  CrossrefPubMedGoogle Scholar
• 37 Abernethy LJ. Classification and imaging of vascular malformations in children. Eur Radiol 2003; 13 (11) 2483-2497
  CrossrefPubMedGoogle Scholar
• 38 Ohgiya Y, Hashimoto T, Gokan T , et al. Dynamic MRI for distinguishing high-flow from low-flow peripheral vascular malformations. AJR Am J Roentgenol 2005; 185 (5) 1131-1137
  CrossrefPubMedGoogle Scholar