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Value of Dynamic Contrast-Enhanced MR Imaging in Diagnosing and Classifying Peripheral Vascular Malformations

¹ Department of Radiology, Leiden University Medical Center, Bldg. 1 C3-Q, 2300 RC Leiden, The Netherlands.
² Department of Surgery, Leiden University Medical Center, Bldg. 1 K6-R, 2300 RC, Leiden, The Netherlands.

View larger version (173K): [in a new window]   Fig. 1A. —18-year-old man with peripheral vascular malformation in vastus intermedius muscle of upper leg. Diagnostic angiography confirmed MR categorization of capillary—venous malformation. Transverse T2-weighted fat-saturated fast spin-echo MR image (TR/TE, 2956/80) exhibits mass consisting of multiple high-signal-intensity dilated venous spaces.

View larger version (96K): [in a new window]   Fig. 1B. —18-year-old man with peripheral vascular malformation in vastus intermedius muscle of upper leg. Diagnostic angiography confirmed MR categorization of capillary—venous malformation. Sagittal dynamic contrast-enhanced subtraction MR image shows start of arterial enhancement (arrowhead) with immediate lesion enhancement (arrow).

View larger version (101K): [in a new window]   Fig. 1C. —18-year-old man with peripheral vascular malformation in vastus intermedius muscle of upper leg. Diagnostic angiography confirmed MR categorization of capillary—venous malformation. Sagittal dynamic contrast-enhanced subtraction MR image, obtained at same level as B but 6 sec later, shows arterial enhancement (arrowhead) and more intense lesion enhancement (arrow). On basis of MR criteria of early lesion enhancement (6 sec after arterial enhancement), presence of dilated venous spaces, and absence of flow voids, we categorized this lesion as capillary—venous malformation.

View larger version (188K): [in a new window]   Fig. 1D. —18-year-old man with peripheral vascular malformation in vastus intermedius muscle of upper leg. Diagnostic angiography confirmed MR categorization of capillary—venous malformation. Arterial phase of superselective angiogram (not wedged) of small branch of superficial femoral artery shows dilated capillaries or small venules (arrow).

View larger version (174K): [in a new window]   Fig. 1E. —18-year-old man with peripheral vascular malformation in vastus intermedius muscle of upper leg. Diagnostic angiography confirmed MR categorization of capillary—venous malformation. Venous phase of angiogram shows contrast pooling in dilated veins (arrow).

View larger version (151K): [in a new window]   Fig. 2A. —50-year-old woman with peripheral vascular malformation of right ear. Enhanced transverse T1-weighted MR image shows enhancement of vascular malformation with serpiginous signal voids (arrow). A = anteriroir, L = left.

View larger version (113K): [in a new window]   Fig. 2B. —50-year-old woman with peripheral vascular malformation of right ear. Dynamic contrast-enhanced subtraction MR image was obtained before arrival of IV bolus of gadopentetate dimeglumine.

View larger version (124K): [in a new window]   Fig. 2C. —50-year-old woman with peripheral vascular malformation of right ear. Dynamic contrast-enhanced subtraction MR image, obtained at same level as B but 3 sec later, shows start of arterial enhancement (arrowhead) with immediate lesion enhancement (arrow).

View larger version (124K): [in a new window]   Fig. 2D. —50-year-old woman with peripheral vascular malformation of right ear. Dynamic contrast-enhanced subtraction MR image, obtained at same level as A and B 3 sec later than C, shows arterial enhancement (arrowhead) and more intense lesion enhancement (arrow). This lesion was categorized on MR imaging as arterial or arteriovenous malformation on basis of early lesion enhancement and presence of flow voids.

View larger version (178K): [in a new window]   Fig. 2E. —50-year-old woman with peripheral vascular malformation of right ear. Selective angiogram of right external carotid artery shows characteristics of arterial malformation. Note dilatation and lengthening of afferent arteries (arrow) followed by early enhancement of enlarged efferent veins (arrowhead) by macrofistulas.

View larger version (121K): [in a new window]   Fig. 3A. —20-year-old man with peripheral vascular malformation of chest wall. Transverse T2-weighted fat-saturated MR image (TR/TE, 2947/80) shows lesion consisting of multiple dilated venous spaces. L = left.

View larger version (108K): [in a new window]   Fig. 3B. —20-year-old man with peripheral vascular malformation of chest wall. Sagittal oblique dynamic contrast-enhanced subtraction MR image, obtained 9 sec after start of arterial enhancement, contains largest part of vascular malformation. No abnormal early lesion enhancement (within 6 sec after arterial enhancement) is exhibited. On basis of MR criteria of late enhancement, presence of dilated venous spaces, and absence of flow voids, we categorized this lesion as venous malformation.

View larger version (145K): [in a new window]   Fig. 3C. —20-year-old man with peripheral vascular malformation of chest wall. Venogram shows percutaneously placed needle and filling of abnormal venous spaces. Superselective angiography showed normal afferent arteries and normal capillary bed (not shown).

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