Clinical and Radiological Evaluation of Periocular Infantile Hemangioma Treated With Oral Propranolol: A Case Series

Ginguerra, Maria Antonieta; Saito, Osmar; Fernandes, José Byron Vicente Dias; Castro, Deborah S.; Matayoshi, Suzana

doi:10.1016/j.ajo.2017.10.021

Cited by 22 publications

(12 citation statements)

References 24 publications

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“…Most IHs were a mixed type, which was a significantly higher proportion in comparison with clinical reports, in which superficial hemangiomas tended to be more frequent 12 . Almost 30% of the IHs showed subclinical involvement of deep structures such as muscles, cartilages, and glands, which is an ultrasound finding that, to our knowledge, has not been previously quantified.…”

Section: Discussioncontrasting

confidence: 61%

Subclinical Ultrasound Characteristics of Infantile Hemangiomas That May Potentially Affect Involution

McNab

García

Tabak

et al. 2020

J of Ultrasound Medicine

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Objectives Infantile hemangiomas (IHs) are the most common benign tumors in children. Color Doppler ultrasound is a noninvasive imaging modality that can show subclinical anatomic parameters in a wide range of dermatologic conditions. The purpose of this study was to describe the ultrasound characteristics of IHs and look for subclinical features with the potential to influence the involution and therapeutic response. Methods A review of the ultrasound database of children with clinical and ultrasound IH diagnoses was conducted. The clinically reported duration and the ultrasound assessment of the proliferative phase were compared. Descriptive and statistical analyses of qualitative and quantitative parameters of the series were performed. Significance was set at P < .05. Results A total of 204 IHs were included. Twenty percent had arteriovenous shunts; 15% had afferent branches from main regional arteries; and almost 30% showed involvement of deep structures. Sixty‐one percent of IHs were in the head and neck. Deep hemangiomas showed significantly thicker lesional vessels. A prolonged proliferative stage was significantly associated with a higher presence of arteriovenous shunts and a higher peak systolic velocity of the arterial vessels (≥15 cm/s) within the lesions. Conclusions Color Doppler ultrasound can support the detection of subclinical anatomic features that may potentially influence the involution and response to treatment of IHs. Some of these characteristics may serve as potential markers to predict and manage IHs in prolonged proliferative stages.

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Section: Discussioncontrasting

confidence: 61%

Subclinical Ultrasound Characteristics of Infantile Hemangiomas That May Potentially Affect Involution

McNab

García

Tabak

et al. 2020

J of Ultrasound Medicine

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“…Magnetic resonance imaging is of great value in accurately making histological and locational diagnoses and in clearly demonstrating the details of lesion structure and spatial anatomical relationships, and thus it has been used in the diagnosis of IH, especially in complex situations such as brain involvement, hepatic hemangioma, orbital hemangioma and parotid hemangioma. [20][21][22][23] We performed MRI to evaluate the involution of deep residual lesions in mixed and deep hemangiomas. With the help of MRI, we found that undegraded hemangioma remained under skin that was considered to be completely involuted into fibrofatty tissue at the age of 5 years.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological outcomes of infantile hemangioma treated with oral propranolol: A long‐term follow‐up study

Zhang

Cai

Chang

et al. 2019

The Journal of Dermatology

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Infantile hemangiomas (IH) undergo rapid growth during early infancy followed by gradual involution. After involution, a part of IH remain as residual lesions. Since 2008, oral propranolol has been widely used in the treatment of IH. However, long‐term outcome of IH treated with propranolol remains unknown. This study aimed to investigate the sequelae of IH treated with propranolol. In this study, propranolol was given at a dose of 2 mg/kg per day at the age of 3.8 ± 2.5 months and follow‐up visits were arranged to continue at least through the age of 4 years. Types of sequela were recorded and classified as four degrees (“none”, “minimal”, “significant” and “severe” at last visit), then subsequent therapy was evaluated with the help of magnetic resonance imaging (MRI). A total of 73 patients with complete follow up were enrolled in the study. The most common types of sequela were telangiectasia, fibrofatty tissue and erythema. Significant and severe sequelae were observed in 72.4% of treated IH; superficial IH led to more but not significantly significant and severe sequelae than mixed IH (P > 0.05). Despite propranolol treatment, surgery was still needed in 37.5% of IH at a mean age of 70.3 months, and for the main reason of surgery, fibrofatty or hemangioma residua, MRI was useful for us to choose an appropriate surgical procedure.

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“…Unlike the cited works (5,16,21,22), our study places exclusive emphasis on the importance and trend of RI in hemangiomas under treatment. RI gives information on the vascular resistance of the lesion and therefore on the perfusion characteristics of the hemangioma, and in particular, it characterizes the arterial flow of the lesion (20, 23,24,26).…”

Section: Discussionmentioning

confidence: 94%

“…It allows an objective documentation of dimensional and anatomical changes of IHs during oral propranolol administration (5). As already stated by some authors, gray-scale and color Doppler ultrasound is a widely available and non-invasive method that not only provides accurate measurements of the dimensions of IHs but also demonstrates their relationships with the surrounding structures and tissues and gives information about the echogenicity of the lesions (2,5,16,21).…”

Section: Discussionmentioning

confidence: 99%

Color Doppler Evaluation of Arterial Resistive Index in Infantile Hemangioma: A Useful Parameter to Monitor the Response to Oral Propranolol?

et al. 2021

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Infantile hemangioma (IH) is the most common benign vascular tumor in childhood. In more than 85% of all cases, IHs undergo spontaneous involution, but nearly 10–12% of IHs develop complications and require immediate therapy. Oral propranolol is currently the first-line treatment for IHs. Color Doppler ultrasound is the gold standard in the diagnosis of deep IH, and it is used to evaluate the morphological change and the modification of vascularization that occur during its evolution and treatment. To date, only few data in the literature described the changes of intralesional arterial resistive index (RI) during treatment with propranolol; particularly, some authors have shown an increase of intralesional arterial RI in IHs with clinical regression during treatment with propranolol. The objective of this paper is to evaluate the changes of RI of the intralesional arteries of the IHs during the treatment with oral propranolol. We retrospectively analyzed a total of 64 IHs in 60 patients treated with oral propranolol with a good clinical response. Gray-scale ultrasonography and color Doppler imaging were performed before and during the therapy. The intralesional RIs were measured before and during the treatment. For each lesion, we recorded the RI values, and then we calculated the mean RI value for any single lesion. We compared the mean RI value observed at the baseline with the mean RI value of the last detectable sampling at color Doppler. We also compared between them the mean RI values observed during intermediate ultrasound. The RI values were compared in 44 lesions, with at least two significant samplings of RI. In the 44 lesions compared, we did not find statistically significant variations in the mean RI values between the baseline control and the values recorded at the last post-treatment control. The time trend of mean RI values of the intermediate color Doppler analysis performed between the first pre-treatment control and the last measurable control did not show any statistically significant variation in the trend of mean RI values. Contrarily to what has been described by some authors, in our experience, we have not observed an increase of RI in IHs treated with oral propranolol.

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Clinical and Radiological Evaluation of Periocular Infantile Hemangioma Treated With Oral Propranolol: A Case Series

Cited by 22 publications

References 24 publications

Subclinical Ultrasound Characteristics of Infantile Hemangiomas That May Potentially Affect Involution

Subclinical Ultrasound Characteristics of Infantile Hemangiomas That May Potentially Affect Involution

Clinical and radiological outcomes of infantile hemangioma treated with oral propranolol: A long‐term follow‐up study

Color Doppler Evaluation of Arterial Resistive Index in Infantile Hemangioma: A Useful Parameter to Monitor the Response to Oral Propranolol?

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