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MRI characteristics and classification of peripheral vascular malformations and tumors

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Abstract

Vascular malformations and tumors comprise a broad spectrum of lesions that can cause significant morbidity and even mortality in children and adults. Classification of vascular malformations into high flow and low flow has significant impact on management since the main treatment of the former is transarterial embolization and the later percutaneous sclerotherapy. Magnetic resonance imaging (MRI) is a noninvasive effective tool for imaging and classification of vascular malformations based on the presence of lobulated masses, signal voids, and hemodynamic flow characteristics. MRI also provides details about anatomic extent of the lesion, proximity to vital structures, and involvement of multiple tissue planes. The prototype of vascular tumors is infantile hemangioma with its typical involution after a proliferative phase during infancy. Hemangioma appears as a distinct intensely enhancing soft tissue mass with enlarged feeding arteries and draining veins. Less common vascular tumors include congenital hemangioma, kaposiform hemangioendothilioma, angiolipoma, angiosarcoma, and hemangiopericytoma.

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References

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

    Article  CAS  Google Scholar 

  2. Lee BB, Choe YH, Ahn JM, et al. The new role of magnetic resonance imaging in the contemporary diagnosis of venous malformation: can it replace angiography? J Am Coll Surg 2004; 198: 549–558.

    Article  Google Scholar 

  3. Yakes WF, Haas DK, Parker SH, et al. Symptomatic vascular malformations: ethanol embolotherapy. Radiology 1989; 170: 1059–1066.

    Article  CAS  Google Scholar 

  4. Lee BB, Kim DI, Huh S, et al. New experiences with absolute ethanol sclerotherapy in the management of a complex form of congenital venous malformation. J Vasc Surg 2001; 33: 764–772.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  6. Yakes WF, Rossi P, Odink H. How I do it. Arteriovenous malformation management. Cardiovasc Intervent Radiol 1996; 19: 65–71.

    Article  CAS  Google Scholar 

  7. Fishman SJ, Mulliken JB. Hemangiomas and vascular malformations of infancy and childhood. Pediatr Clin North Am 1993; 40: 1177–1200.

    Article  CAS  Google Scholar 

  8. Chang MW. Updated classification of hemangiomas and other vascular anomalies. Lymphat Res Biol 2003; 1: 259–265.

    Article  Google Scholar 

  9. Abernethy LJ. Classification and imaging of vascular malformations in children. Eur Radiol 2003; 13: 2483–2497.

    Article  Google Scholar 

  10. Rak KM, Yakes WF, Ray RL, et al. MR imaging of symptomatic peripheral vascular malformations. AJR Am J Roentgenol 1992; 159: 107–112.

    Article  CAS  Google Scholar 

  11. Herborn CU, Goyen M, Lauenstein TC, Debatin JF, Ruehm SG, Kroger K. Comprehensive time-resolved MRI of peripheral vascular malformations. AJR Am J Roentgenol 2003; 181: 729–735.

    Article  Google Scholar 

  12. 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: 1181–1187.

    Article  Google Scholar 

  13. 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: 1131–1137.

    Article  Google Scholar 

  14. Finn MC, Glowacki J, Mulliken JB. Congenital vascular lesions: clinical application of a new classification. J Pediatr Surg 1983; 18: 894–900.

    Article  CAS  Google Scholar 

  15. Young AE. Pathogenesis of the vascular malformations. In: Mulliken JB, Young AE, editors. Vascular birthmarks: hemangiomas and malformations. Philadelphia: Saunders; 1988. p. 107–112.

    Google Scholar 

  16. Rosen RJ, Riles TS. Congenital vascular malformations. In: Rutherford RB, editor. Vascular surgery. 5th ed. Philadelphia: W.B. Saunders; 2000. p. 1451–1565.

    Google Scholar 

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

    Article  CAS  Google Scholar 

  18. Laor T, Burrows PE. Congenital anomalies and vascular birthmarks of the lower extremities. Magn Reson Imaging Clin N Am 1998; 6: 497–519.

    CAS  PubMed  Google Scholar 

  19. Breugem CC, Maas M, van der Horst CM. Magnetic resonance imaging findings of vascular malformations of the lower extremity. Plast Reconstr Surg 2001; 108: 878–884.

    Article  CAS  Google Scholar 

  20. Mulliken JB, Fishman SJ, Burrows PE. Vascular anomalies. Curr Probl Surg 2000; 37: 517–584.

    Article  CAS  Google Scholar 

  21. Boon LM, Mulliken JB, Enjolras O, Vikkula M. Glomuvenous malformation (glomangioma) and venous malformation: distinct clinicopathologic and genetic entities. Arch Dermatol 2004; 140: 971–976.

    Article  Google Scholar 

  22. Dubois J, Soulez G, Oliva VL, Berthiaume MJ, Lapierre C, Therasse E. Soft-tissue venous malformations in adult patients: imaging and therapeutic issues. Radiographics 2001; 21: 1519–1531.

    Article  CAS  Google Scholar 

  23. Rinker B, Karp NS, Margiotta M, Blei F, Rosen R, Rofsky NM. The role of magnetic resonance imaging in the management of vascular malformations of the trunk and extremities. Plast Reconstr Surg 2003; 112: 504–510.

    Article  Google Scholar 

  24. Upton J, Mulliken JB, Murray JE. Classification and rationale for management of vascular anomalies in the upper extremity. J Hand Surg [Am] 1985; 10: 970–975.

    Article  CAS  Google Scholar 

  25. Enjolras O, Ciabrini D, Mazoyer E, Laurian C, Herbreteau D. Extensive pure venous malformations in the upper or lower limb: a review of 27 cases. J Am Acad Dermatol 1997; 36: 219–225.

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  27. de Lorimier AA. Sclerotherapy for venous malformations. J Pediatr Surg 1995; 30: 188–193. discussion 194.

    Article  Google Scholar 

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

    Article  CAS  Google Scholar 

  29. Koeller KK, Alamo L, Adair CF, Smirniotopoulos JG. Congenital cystic masses of the neck: radiologic–pathologic correlation. Radiographics 1999; 19: 121–146. quiz 152–123.

    Article  CAS  Google Scholar 

  30. Dubois J, Garel L. Imaging and therapeutic approach of hemangiomas and vascular malformations in the pediatric age group. Pediatr Radiol 1999; 29: 879–893.

    Article  CAS  Google Scholar 

  31. Sanlialp I, Karnak I, Tanyel FC, Senocak ME, Buyukpamukcu N. Sclerotherapy for lymphangioma in children. Int J Pediatr Otorhinolaryngol 2003; 67: 795–800.

    Article  CAS  Google Scholar 

  32. Marler JJ, Mulliken JB. Current management of hemangiomas and vascular malformations. Clin Plast Surg 2005; 32: 99–116. ix.

    Article  Google Scholar 

  33. Harsha WJ, Perkins JA, Lewis CW, Manning SC. Pediatric admissions and procedures for lymphatic malformations in the United States: 1997 and 2000. Lymphat Res Biol 2005; 3: 58–65.

    Article  Google Scholar 

  34. Burrows PE, Laor T, Paltiel H, Robertson RL. Diagnostic imaging in the evaluation of vascular birthmarks. Dermatol Clin 1998; 16: 455–488.

    Article  CAS  Google Scholar 

  35. Siegel MJ, Glazer HS, St Amour TE, Rosenthal DD. Lymphangiomas in children: MR imaging. Radiology 1989; 170: 467–470.

    Article  CAS  Google Scholar 

  36. Requena L, Sangueza OP. Cutaneous vascular proliferation. Part II. Hyperplasias and benign neoplasms. J Am Acad Dermatol 1997; 37: 887–919. quiz 920–882.

    Article  CAS  Google Scholar 

  37. Requena L, Sangueza OP. Cutaneous vascular anomalies. Part I. Hamartomas, malformations, and dilation of preexisting vessels. J Am Acad Dermatol 1997; 37: 523–549. quiz 549–552.

    Article  CAS  Google Scholar 

  38. Jacobs AH, Walton RG. The incidence of birthmarks in the neonate. Pediatrics 1976; 58: 218–222.

    CAS  PubMed  Google Scholar 

  39. Thomas-Sohl KA, Vaslow DF, Maria BL. Sturge–Weber syndrome: a review. Pediatr Neurol 2004; 30: 303–310.

    Article  Google Scholar 

  40. Bloem JL, van der Woude HJ, Geirnaerdt MJ, Taminiau AH, Hogendoorn PC, van Rijswijk CS. Bone tumors. Eur Radiol 2000; 10: 207–212.

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  42. Lawdahl RB, Routh WD, Vitek JJ, McDowell HA, Gross GM, Keller FS. Chronic arteriovenous fistulas masquerading as arteriovenous malformations: diagnostic considerations and therapeutic implications. Radiology 1989; 170: 1011–1015.

    Article  CAS  Google Scholar 

  43. Bartels C, Horsch S. Classification of congenital arterial and venous vascular malformations. Angiology 1995; 46: 191–200.

    Article  CAS  Google Scholar 

  44. Enjolras O, Logeart I, Gelbert F, et al. [Arteriovenous malformations: a study of 200 cases]. Ann Dermatol Venereol 2000; 127: 17–22.

    CAS  PubMed  Google Scholar 

  45. Lee BB, Do YS, Yakes W, Kim DI, Mattassi R, Hyon WS. Management of arteriovenous malformations: a multidisciplinary approach. J Vasc Surg 2004; 39: 590–600.

    Article  Google Scholar 

  46. Cohen JM, Weinreb JC, Redman HC. Arteriovenous malformations of the extremities: MR imaging. Radiology 1986; 158: 475–479.

    Article  CAS  Google Scholar 

  47. Berenguer B, Mulliken JB, Enjolras O, et al. Rapidly involuting congenital hemangioma: clinical and histopathologic features. Pediatr Dev Pathol 2003; 6: 495–510.

    Article  Google Scholar 

  48. Enjolras O, Wassef M, Mazoyer E, et al. Infants with Kasabach–Merritt syndrome do not have “true” hemangiomas. J Pediatr 1997; 130: 631–640.

    Article  CAS  Google Scholar 

  49. Meyer JS, Hoffer FA, Barnes PD, Mulliken JB. Biological classification of soft-tissue vascular anomalies: MR correlation. AJR Am J Roentgenol 1991; 157: 559–564.

    Article  CAS  Google Scholar 

  50. Boon LM, Fishman SJ, Lund DP, Mulliken JB. Congenital fibrosarcoma masquerading as congenital hemangioma: report of two cases. J Pediatr Surg 1995; 30: 1378–1381.

    Article  CAS  Google Scholar 

  51. Hayward PG, Orgill DP, Mulliken JB, Perez-Atayde AR. Congenital fibrosarcoma masquerading as lymphatic malformation: report of two cases. J Pediatr Surg 1995; 30: 84–88.

    Article  CAS  Google Scholar 

  52. Boon LM, Enjolras O, Mulliken JB. Congenital hemangioma: evidence of accelerated involution. J Pediatr 1996; 128: 329–335.

    Article  CAS  Google Scholar 

  53. 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: 1178–1185.

    Article  Google Scholar 

  54. Enjolras O, Mulliken JB, Boon LM, Wassef M, Kozakewich HP, Burrows PE. Noninvoluting congenital hemangioma: a rare cutaneous vascular anomaly. Plast Reconstr Surg 2001; 107: 1647–1654.

    Article  CAS  Google Scholar 

  55. 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: 1377–1386.

    Article  CAS  Google Scholar 

  56. Murphey MD, Fairbairn KJ, Parman LM, Baxter KG, Parsa MB, Smith WS. From the archives of the AFIP. Musculoskeletal angiomatous lesions: radiologic–pathologic correlation. Radiographics 1995; 15: 893–917.

    Article  CAS  Google Scholar 

  57. Enzinger FM, Weiss SW. Perivascular tumors. In: Enzinger FM, Weiss SW, editors. Soft tissue tumors. 3rd ed. St. Louis: Mosby; 1995. p. 701–733.

    Google Scholar 

  58. Lin JJ, Lin F. Two entities in angiolipoma. A study of 459 cases of lipoma with review of literature on infiltrating angiolipoma. Cancer 1974; 34: 720–727.

    Article  CAS  Google Scholar 

  59. Chew FS, Hudson TM, Hawkins IF Jr. Radiology of infiltrating angiolipoma. AJR Am J Roentgenol 1980; 135: 781–787.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA

    Hicham Moukaddam, Jeffrey Pollak & Andrew H. Haims

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  1. Hicham Moukaddam
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  2. Jeffrey Pollak
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Correspondence to Andrew H. Haims.

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Moukaddam, H., Pollak, J. & Haims, A.H. MRI characteristics and classification of peripheral vascular malformations and tumors. Skeletal Radiol 38, 535–547 (2009). https://doi.org/10.1007/s00256-008-0609-2

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