Dynamic MRA 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]. Dynamic 4-D MRA with IV contrast may be used to detect presence of arteriovenous microshunts in VMs, which have been found to be associated with presence of phleboliths [30]. 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 using T1-weighted sequences, and T2-weighted images reveal vascular flow voids as well as fluid filled spaces. Areas of signal loss or flow voids are important to document and can help drive the diagnosis (phleboliths versus fast-flow vessels). A well-defined soft tissue mass is not typically identified in AVM. IV contrast shows intense enhancement of involved soft tissues, cyst walls, and/or vascular structures [31]. 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 next imaging modality for vascular lesion such as tumor or malformation. Radiography Area of Interest There is no relevant literature to support the use of radiography area of interest as the next imaging modality for VMs [35]. US Area of Interest With IV Contrast There is no relevant literature to support the use of US area of interest with IV contrast as the initial imaging modality for patients with vascular lesions such as tumor or malformation [48]. Variant 5: Child. Established diagnosis of vascular malformation presenting with new or persistent signs or symptoms. Initial imaging. VMs are a diverse group of lesions, which are difficult to treat, requiring multiple episodes of interventional embolization/sclerotherapy and or surgical intervention over years of treatment.
Soft Tissue Vascular Anomalies Vascular Malformations and Infantile Vascular Tumors Non CNS Child. Dynamic MRA 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]. Dynamic 4-D MRA with IV contrast may be used to detect presence of arteriovenous microshunts in VMs, which have been found to be associated with presence of phleboliths [30]. 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 using T1-weighted sequences, and T2-weighted images reveal vascular flow voids as well as fluid filled spaces. Areas of signal loss or flow voids are important to document and can help drive the diagnosis (phleboliths versus fast-flow vessels). A well-defined soft tissue mass is not typically identified in AVM. IV contrast shows intense enhancement of involved soft tissues, cyst walls, and/or vascular structures [31]. 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 next imaging modality for vascular lesion such as tumor or malformation. Radiography Area of Interest There is no relevant literature to support the use of radiography area of interest as the next imaging modality for VMs [35]. US Area of Interest With IV Contrast There is no relevant literature to support the use of US area of interest with IV contrast as the initial imaging modality for patients with vascular lesions such as tumor or malformation [48]. Variant 5: Child. Established diagnosis of vascular malformation presenting with new or persistent signs or symptoms. Initial imaging. VMs are a diverse group of lesions, which are difficult to treat, requiring multiple episodes of interventional embolization/sclerotherapy and or surgical intervention over years of treatment.