MRA and MRV Area of Interest Without and With IV Contrast MRA and MRV of the area of interest without and with IV contrast may be used to update venous and arterial anatomy as well as better differentiate the tissue types involved in the VM. As embolization and sclerotherapy treatments change the vascular channels, MRA can provide updated information. Contrast-enhanced 3-D and 4-D dynamic MRA acquisitions are helpful in assessing flow through the lesion before and after treatment, the location of a new nidus in an AVM, and a new vascular fistula in an AVF. Dynamic MRA and MRV combined with contrast-enhanced MRI has been shown to have excellent sensitivity (83%) and specificity (95%) in differentiating low-flow from fast-flow VMs [29,47]. Embolization and sclerotherapy are expected to change the shunting within these low-flow VMs. MRI Area of Interest Without and With IV Contrast MRI of the area of interest without and with IV contrast may be used to define the deep and superficial extent of VM with expected treatment changes. IV contrast shows intense enhancement of involved soft tissues, cyst walls, and/or vascular structures [31]. Particular attention may need to be paid to imaging findings that may suggest treatment complications (abscess, tissue necrosis, cellulitis, deep vein thrombosis, etc). MRI Area of Interest Without IV Contrast There is no relevant literature to support the use of MRI area of interest without IV contrast as the initial imaging modality for patients with an established diagnosis of VM presenting with new or persistent signs and symptoms. Radiography Area of Interest Radiographs of the area of interest may reveal calcified phleboliths and embolization material within a previously treated VM; these findings may be helpful in choosing a follow-up imaging study (ie, US for suspected occluded deep vein after sclerotherapy).
Soft Tissue Vascular Anomalies Vascular Malformations and Infantile Vascular Tumors Non CNS Child. MRA and MRV Area of Interest Without and With IV Contrast MRA and MRV of the area of interest without and with IV contrast may be used to update venous and arterial anatomy as well as better differentiate the tissue types involved in the VM. As embolization and sclerotherapy treatments change the vascular channels, MRA can provide updated information. Contrast-enhanced 3-D and 4-D dynamic MRA acquisitions are helpful in assessing flow through the lesion before and after treatment, the location of a new nidus in an AVM, and a new vascular fistula in an AVF. Dynamic MRA and MRV combined with contrast-enhanced MRI has been shown to have excellent sensitivity (83%) and specificity (95%) in differentiating low-flow from fast-flow VMs [29,47]. Embolization and sclerotherapy are expected to change the shunting within these low-flow VMs. MRI Area of Interest Without and With IV Contrast MRI of the area of interest without and with IV contrast may be used to define the deep and superficial extent of VM with expected treatment changes. IV contrast shows intense enhancement of involved soft tissues, cyst walls, and/or vascular structures [31]. Particular attention may need to be paid to imaging findings that may suggest treatment complications (abscess, tissue necrosis, cellulitis, deep vein thrombosis, etc). MRI Area of Interest Without IV Contrast There is no relevant literature to support the use of MRI area of interest without IV contrast as the initial imaging modality for patients with an established diagnosis of VM presenting with new or persistent signs and symptoms. Radiography Area of Interest Radiographs of the area of interest may reveal calcified phleboliths and embolization material within a previously treated VM; these findings may be helpful in choosing a follow-up imaging study (ie, US for suspected occluded deep vein after sclerotherapy).