Pediatric Radiology

, Volume 46, Issue 3, pp 413–421 | Cite as

Early experience with X-ray magnetic resonance fusion for low-flow vascular malformations in the pediatric interventional radiology suite

  • Tiffany J. HwangEmail author
  • Erin Girard
  • Sphoorti Shellikeri
  • Randolph Setser
  • Arastoo Vossough
  • Victor Ho-Fung
  • Anne Marie Cahill
Technical Innovation


This technical innovation describes our experience using an X-ray magnetic resonance fusion (XMRF) software program to overlay 3-D MR images on real-time fluoroscopic images during sclerotherapy procedures for vascular malformations at a large pediatric institution. Five cases have been selected to illustrate the application and various clinical utilities of XMRF during sclerotherapy procedures as well as the technical limitations of this technique. The cases demonstrate how to use XMRF in the interventional suite to derive additional information to improve therapeutic confidence with regards to the extent of lesion filling and to guide clinical management in terms of intraprocedural interventional measures.


Children Image fusion Interventional radiology Sclerotherapy Vascular imaging Vascular malformations 


Compliance with Ethical Standards

Conflicts of interest

E. Girard, PhD, is an employee of Siemens Corporation, Corporate Technology, and R. Setser, PhD, is an employee of Siemens Medical Solutions, USA, Inc.


  1. 1.
    Cahill AM, Nijs ELF (2011) Pediatric vascular malformations: pathophysiology, diagnosis, and the role of interventional radiology. Cardiovasc Intervent Radiol 34:691–704CrossRefPubMedGoogle Scholar
  2. 2.
    Kollipara R, Dinneen L, Rentas KE et al (2013) Current classification and terminology of pediatric vascular anomalies. AJR Am J Roentgenol 201:1124–1135CrossRefPubMedGoogle Scholar
  3. 3.
    Tacher V, Lin M, Desgranges P et al (2013) Image guidance for endovascular repair of complex aortic aneurysms: comparison of two-dimensional and three-dimensional angiography and image fusion. J Vasc Interv Radiol 24:1698–1706PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Fukuda T, Matsuda H, Doi S et al (2013) Evaluation of automated 2D-3D image overlay system utilizing subtraction of bone marrow image for EVAR: feasibility study. Eur J Vasc Endovasc Surg 46:75–81CrossRefPubMedGoogle Scholar
  5. 5.
    Ernemann U, Westendorff C, Troitzsch D et al (2004) Navigation-assisted sclerotherapy of orbital venolymphatic malformation: a new guidance technique for percutaneous treatment of low-flow vascular malformations. AJNR Am J Neuroradiol 25:1792–1795PubMedGoogle Scholar
  6. 6.
    Lightfoot CB, Ju Y, Dubois J et al (2013) Cone-beam CT: an additional imaging tool in the interventional treatment and management of low-flow vascular malformations. J Vasc Interv Radiol 24:981–988CrossRefPubMedGoogle Scholar
  7. 7.
    Levitt MR, Vaidya SS, Su DK et al (2013) The “triple-overlay” technique for percutaneous diagnosis and treatment of lesions of the head and neck: combined three-dimensional guidance with magnetic resonance imaging, cone-beam computed tomography, and fluoroscopy. World Neurosurg 79:509–514CrossRefPubMedGoogle Scholar
  8. 8.
    Dori Y, Sarmiento M, Glatz AC et al (2011) X-ray magnetic resonance fusion to internal markers and utility in congenital heart disease catheterization. Circ Cardiovasc Imaging 4:415–424PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    Nehra D, Jacobson L, Barnes P et al (2008) Doxycycline sclerotherapy as primary treatment of head and neck lymphatic malformations in children. J Pediatr Surg 43:451–460CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Tiffany J. Hwang
    • 1
    • 2
    Email author
  • Erin Girard
    • 3
  • Sphoorti Shellikeri
    • 1
  • Randolph Setser
    • 4
  • Arastoo Vossough
    • 1
  • Victor Ho-Fung
    • 1
  • Anne Marie Cahill
    • 1
  1. 1.Department of RadiologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Keck School of Medicine of the University of Southern CaliforniaLos AngelesUSA
  3. 3.Corporate TechnologySiemens CorporationPrincetonUSA
  4. 4.Siemens Medical Solutions USA, Inc.Hoffman EstatesUSA

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