MRA is noninvasive and can depict the vascular anatomy of a malformation nearly as well as arteriography [9], making it the preferred initial imaging evaluation. Arteriography does offer the highest resolution imaging of small vessels and superior temporal resolution for assessment of flow dynamics. These advantages may be useful for high-flow lesions when MRA findings are equivocal or when treatment planning requires the highest available vascular detail resolution and/or better estimation of intralesional shunting [5-8]. Variant 2: Upper or lower extremity. Vascular murmur (bruit or thrill). Initial imaging. The body regions covered in this clinical scenario are shoulder, humerus, elbow, forearm, wrist, hand, hip, femur, knee, tibia/fibula, ankle, and foot. Radiography Extremity Radiographs are of limited benefit for the specific purpose of vascular malformation imaging, especially in regard to lesions presenting with a vascular murmur. Radiographs may be normal or show a soft-tissue mass [5,12]. Venous malformations and hemangiomas may contain radiographically visible phleboliths in 20% to 67% of cases, which provide a clue to the diagnosis; however, these lesions typically do not present with a vascular murmur [3,12]. Lesions located adjacent to bone may be associated with bone changes, such as periosteal reaction, remodeling, or signs of destruction, such as cortical scalloping and lucencies. Although such findings may be visible radiographically, they are not specific for the diagnosis of vascular malformations [6,12]. Vascular Malformation of the Extremities US Duplex Doppler Extremity US is fast and can often provide initial imaging characterization of vascular malformations [5-7,13]. The presence of a vascular murmur is clinically suggestive of a high-flow malformation, and US with Doppler imaging is generally regarded as a good initial option for the confirmation of a high-flow component.
Clinically Suspected Vascular Malformation of the Extremities. MRA is noninvasive and can depict the vascular anatomy of a malformation nearly as well as arteriography [9], making it the preferred initial imaging evaluation. Arteriography does offer the highest resolution imaging of small vessels and superior temporal resolution for assessment of flow dynamics. These advantages may be useful for high-flow lesions when MRA findings are equivocal or when treatment planning requires the highest available vascular detail resolution and/or better estimation of intralesional shunting [5-8]. Variant 2: Upper or lower extremity. Vascular murmur (bruit or thrill). Initial imaging. The body regions covered in this clinical scenario are shoulder, humerus, elbow, forearm, wrist, hand, hip, femur, knee, tibia/fibula, ankle, and foot. Radiography Extremity Radiographs are of limited benefit for the specific purpose of vascular malformation imaging, especially in regard to lesions presenting with a vascular murmur. Radiographs may be normal or show a soft-tissue mass [5,12]. Venous malformations and hemangiomas may contain radiographically visible phleboliths in 20% to 67% of cases, which provide a clue to the diagnosis; however, these lesions typically do not present with a vascular murmur [3,12]. Lesions located adjacent to bone may be associated with bone changes, such as periosteal reaction, remodeling, or signs of destruction, such as cortical scalloping and lucencies. Although such findings may be visible radiographically, they are not specific for the diagnosis of vascular malformations [6,12]. Vascular Malformation of the Extremities US Duplex Doppler Extremity US is fast and can often provide initial imaging characterization of vascular malformations [5-7,13]. The presence of a vascular murmur is clinically suggestive of a high-flow malformation, and US with Doppler imaging is generally regarded as a good initial option for the confirmation of a high-flow component.