La radiologia medica

, Volume 123, Issue 8, pp 563–571 | Cite as

MRI evaluation of peripheral vascular anomalies using time-resolved imaging of contrast kinetics (TRICKS) sequence

  • Nicolò Schicchi
  • Corrado Tagliati
  • Giacomo Agliata
  • Paolo Esposto Pirani
  • Raffaella Spadari
  • Andrea Giovagnoni



We describe the use of time-resolved imaging of contrast kinetics (TRICKS) sequence in the diagnosis of Peripheral Vascular Anomalies. In case of suspected vascular malformations time-resolved MR angiography might add important information for therapeutic decisions and follow-up.


The objective of our study was to assess the usefulness and diagnostic performance of time-resolved imaging of contrast kinetics sequence in the evaluation of peripheral vascular anomalies.

Subjects and methods

Sixty-six patients (23 pediatric, 43 adult; mean age 26) affected by upper or lower limb vascular anomalies and studied using time-resolved imaging of contrast kinetics sequence were prospectively evaluated. All studies were performed on a 1.5-T whole-body MR system. Two independent readers tried to categorized the suspected vascular anomalies in pre-contrast and post-contrast MR sequences and assessed the overall TRICKS image quality. In 11 patients, the diagnostic performance comparability between TRICKS sequence and digital subtraction angiography was evaluated.


On the basis of time-resolved imaging of contrast kinetics, 31 of the vascular anomalies were classified as high-flow vascular malformations, 29 as low-flow vascular lesions and 6 as hemangiomas. There was no significant difference in image quality evaluation and vascular anomaly classification between the two observers. The vascular anomalies characteristics provided by moderate, good or excellent quality TRICKS images were confirmed by digital subtraction angiography.


Time-resolved imaging of contrast kinetics sequence let the radiologist to acquire useful temporal information to correctly evaluate vascular anomalies components, adding more data to those provided by conventional MR sequences, especially in case of arteriovenous malformation. Therefore, both in pediatric and adult population, TRICKS could be used as an additional initial diagnostic tool to rightly classify these lesions and evaluate if a treatment is needed and which.


MR angiography Vascular anomalies Arteriovenous malformation TRICKS sequence TR-MRA 


Compliance with ethical standards

Conflict of interest

The authors declared no potential conflicts of interests associated with this study.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants (or their parental guardian) included in the study.


  1. 1.
    Greene AK, Kim S, Rogers GF, Fishman SJ, Olsen BR, Mulliken JB (2008) Risk of vascular anomalies with down syndrome. Pediatrics 121:e135–e140. CrossRefPubMedGoogle Scholar
  2. 2.
    Jacobs AH, Walton RG (1976) The incidence of birthmarks in the neonate. Pediatrics 58:218–222PubMedGoogle Scholar
  3. 3.
    Kilcline C, Frieden IJ (2008) Infantile hemangiomas: how common are they? A systematic review of the medical literature. Pediatr Dermatol 25:168–173. CrossRefPubMedGoogle Scholar
  4. 4.
    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 31:462–471CrossRefPubMedGoogle Scholar
  5. 5.
    Dubois J, Soulez G, Oliva VL, Berthiaume MJ, Lapierre C, Therasse E (2001) Soft-tissue venous malformations in adult patients: imaging and therapeutic issues. Radiographics 21:1519–1531. CrossRefPubMedGoogle Scholar
  6. 6.
    ISSVA Classification of Vascular Anomalies ©2014 International Society for the Study of Vascular Anomalies. Available at Accessed 8 Feb 2017
  7. 7.
    Dubois J, Alison M (2010) Vascular anomalies: what a radiologist needs to know. Pediatr Radiol 40:895–905. CrossRefPubMedGoogle Scholar
  8. 8.
    Paltiel HJ, Burrows PE, Kozakewich HP, Zurakowski D, Mulliken JB (2000) Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology 214:747–754. CrossRefPubMedGoogle Scholar
  9. 9.
    Konez O, Burrows PE (2002) Magnetic resonance imaging of vascular anomalies. Magn Reson Imaging Clin N Am 10:363–388CrossRefPubMedGoogle Scholar
  10. 10.
    Moukaddam H, Pollak J, Haims AH (2009) MRI characteristics and classification of peripheral vascular malformations and tumors. Skeletal Radiol 38:535–547. CrossRefPubMedGoogle Scholar
  11. 11.
    Ohgiya Y, Hashimoto T, Gokan T, Watanabe S, Kuroda M, Hirose M, Matsui S, Nobusawa H, Kitanosono T, Munechika H (2005) Dynamic MRI for distinguishing high-flow from low-flow peripheral vascular malformations. AJR Am J Roentgenol 185:1131–1137. CrossRefPubMedGoogle Scholar
  12. 12.
    Hennig J, Scheffler K, Laubenberger J, Strecker R (1997) Time-resolved projection angiography after bolus injection of contrast agent. Magn Reson Med 37:341–345CrossRefPubMedGoogle Scholar
  13. 13.
    Elster AD (2017) Time-resolved MRA. Questions and answers in MRI web site. Accessed 26 March 2017
  14. 14.
    Higashihara H, Osuga K, Ueguchi T, Onishi H, Tanaka H, Maeda N, Tomoda K, Tomiyama N (2012) Usefulness of contrast-enhanced three-dimensional MR angiography using time-resolved imaging of contrast kinetics applied to description of extracranial arteriovenous malformations: initial experience. Eur J Radiol 81:1134–1139. CrossRefPubMedGoogle Scholar
  15. 15.
    Kramer U, Ernemann U, Mangold S, Seeger A, Bretschneider C, Miller S, Claussen CD, Fenchel MC (2012) Diagnostic value of high spatial and temporal resolution time-resolved MR angiography in the workup of peripheral high-flow vascular malformations at 1.5 Tesla. Int J Cardiovasc Imaging 28:823–834. CrossRefPubMedGoogle Scholar
  16. 16.
    Anzidei M, Cavallo Marincola B, Napoli A, Saba L, Zaccagna F, Lucatelli P, Fanelli F, Bassetti E, Salvatori FM, Catalano C, Passariello R (2011) Low-dose contrast-enhanced time-resolved MR angiography at 3T: diagnostic accuracy for treatment planning and follow-up of vascular malformations. Clin Radiol. 66:1181–1192. CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2018

Authors and Affiliations

  1. 1.SOD Radiologia Pediatrica e Specialistica, Azienda Ospedaliero Universitaria Ospedali RiunitiUniversità Politecnica delle MarcheAnconaItaly
  2. 2.School of RadiologyUniversità Politecnica delle MarcheAnconaItaly

Personalised recommendations