Imaging of peripheral vascular malformations — current concepts and future perspectives

Schmidt, Volker J.; Masthoff, Max; Czihal, Michael; Cucuruz, Beatrix; Häberle, Beate; Brill, Richard; Wohlgemuth, Walter A.; Wildgruber, Moritz

doi:10.1186/s40348-021-00132-w

Cited by 24 publications

(30 citation statements)

References 106 publications

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“…Data collection was performed using electronic patient records as well as the Picture Archiving and Communication System (PACS) searching for corresponding diagnosis related groups (DRGs). Arteriovenous malformations (AVMs) were diagnosed based on the combination of patient history, physical examination, and imaging using magnetic resonance imaging (MRI) and duplex ultrasound [9,10]. Clinical and angiographic classifications were assessed according to Schobinger and Cho [11].…”

Section: Methodsmentioning

confidence: 99%

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Schmidt

Masthoff

Brill

et al. 2022

Cardiovasc Intervent Radiol

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Purpose To evaluate the safety and outcome of image-guided embolotherapy of extracranial arteriovenous malformations (AVMs) primarily affecting the face. Materials and Methods A multicenter cohort of 28 patients presenting with AVMs primarily affecting the face was retrospectively investigated. Fifty image-guided embolotherapies were performed, mostly using ethylene–vinyl alcohol copolymer-based embolic agents. Clinical and imaging findings were assessed to evaluate response during follow-up (symptom-free, partial relief of symptoms, no improvement, and progression despite embolization), lesion devascularization (total, 100%; substantial, 76–99%; partial, 51–75%; failure, < 50%; and progression), and complication rates (classified according to the CIRSE guidelines). Sub-analyses regarding clinical outcome (n = 24) were performed comparing patients with (n = 12) or without (n = 12) subsequent surgical resection after embolotherapy. Results The median number of embolotherapy sessions was 2.0 (range, 1–4). Clinical outcome after a mean follow-up of 12.4 months (± 13.3; n = 24) revealed a therapy response in 21/24 patients (87.5%). Imaging showed total devascularization in 14/24 patients (58.3%), including the 12 patients with subsequent surgery and 2 additional patients with embolotherapy only. Substantial devascularization (76–99%) was assessed in 7/24 patients (29.2%), and partial devascularization (51–75%) in 3/24 patients (12.5%). Complications occurred during/after 12/50 procedures (24.0%), including 18.0% major complications. Patients with subsequent surgical resections were more often symptom-free at the last follow-up compared to the group having undergone embolotherapy only (p = 0.006). Conclusion Image-guided embolotherapy is safe and effective for treating extracranial AVMs of the face. Subsequent surgical resections after embolization may substantially improve patients’ clinical outcome, emphasizing the need for multimodal therapeutic concepts. Level of Evidence Level 4, Retrospective study.

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Section: Methodsmentioning

confidence: 99%

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Schmidt

Masthoff

Brill

et al. 2022

Cardiovasc Intervent Radiol

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“…Data collection was performed using electronic patient records as well as the Picture Archiving and Communication System (PACS) searching for corresponding diagnosis related groups (DRGs). VMs were diagnosed based on the combination of patient history, physical examination, and imaging using magnetic resonance imaging (MRI) as well as duplex ultrasound ( 9 ). The angiographic classification was performed according to Puig et al ( 10 ).…”

Section: Methodsmentioning

confidence: 99%

Multicentered analysis of percutaneous sclerotherapies in venous malformations of the face

et al. 2022

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ObjectivesTo evaluate the safety and outcome of image-guided sclerotherapy for treating venous malformations (VMs) of the face.Materials and methodsA multicenter cohort of 68 patients with VMs primarily affecting the face was retrospectively investigated. In total, 142 image-guided sclerotherapies were performed using gelified ethanol and/or polidocanol. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Sub-analyses of complication rates depending on type and injected volume of the sclerosant as well as of pediatric versus adult patient groups were conducted.ResultsMean number of procedures per patient was 2.1 (±1.7) and mean follow-up consisted of 8.7 months (±6.8 months). Clinical response (n = 58) revealed a partial relief of symptoms in 70.7% (41/58), 13/58 patients (22.4%) presented symptom-free while only 4/58 patients (6.9%) reported no improvement. Post-treatment imaging (n = 52) revealed an overall objective response rate of 86.5% (45/52). The total complication rate was 10.6% (15/142) including 4.2% (7/142) major complications, mostly (14/15, 93.3%) resolved by conservative means. In one case, a mild facial palsy persisted over time. The complication rate in the gelified ethanol subgroup was significantly higher compared to polidocanol and to the combination of both sclerosants (23.5 vs. 6.0 vs. 8.3%, p = 0.01). No significant differences in complications between the pediatric and the adult subgroup were observed (12.1 vs. 9.2%, p = 0.57). Clinical response did not correlate with lesion size reduction on magnetic resonance imaging (MRI).ConclusionImage-guided sclerotherapy is effective for treating VMs of the face. Clinical response is not necessarily associated with size reduction on imaging. Despite the complex anatomy of this location, the procedures are safe for both adults and children.

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“…Currently, no reliable baseline clinical or imaging parameters exist to predict patient outcome following percutaneous sclerotherapy. Imaging in VMs is based on ultrasound and magnetic resonance imaging (MRI) [ 5 ]. Since diffusion-weighted (dw) magnetic resonance imaging (MRI) depends on the intralesional diffusion of water molecules, which may be restricted in slow-flow malformations either by partial thrombosis or after sclerotherapy, dw-MRI may provide useful predictive parameters for the effectiveness of sclerotherapy [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Diffusion-Weighted Imaging Prior to Percutaneous Sclerotherapy of Venous Malformations—Proof of Concept Study for Prediction of Clinical Outcome

Gerwing

Schindler

Schneider³

et al. 2022

Diagnostics

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Prediction of response to percutaneous sclerotherapy in patients with venous malformations (VM) is currently not possible with baseline clinical or imaging characteristics. This prospective single-center study aimed to predict treatment outcome of percutaneous sclerotherapy as measured by quality of life (QoL) by using radiomic analysis of diffusion-weighted (dw) magnetic resonance imaging (MRI) before and after first percutaneous sclerotherapy. In all patients (n = 16) pre-interventional (PRE-) and delta (DELTA-) radiomic features (RF) were extracted from dw-MRI before and after first percutaneous sclerotherapy with ethanol gel or polidocanol foam, while QoL was assessed using the Toronto Extremity Salvage Score (TESS) and the 36-Item Short Form Survey (SF-36) health questionnaire. For selecting features that allow differentiation of clinical response, a stepwise dimension reduction was performed. Logistic regression models were fitted and selected PRE-/DELTA-RF were tested for their predictive value. QoL improved significantly after percutaneous sclerotherapy. While no common baseline patient characteristics were able to predict response to percutaneous sclerotherapy, the radiomics signature of VMs (independent PRE/DELTA-RF) revealed high potential for the prediction of clinical response after percutaneous sclerotherapy. This proof-of-concept study provides first evidence on the potential predictive value of (delta) radiomic analysis from diffusion-weighted MRI for Quality-of-Life outcome after percutaneous sclerotherapy in patients with venous malformations.

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Imaging of peripheral vascular malformations — current concepts and future perspectives

Cited by 24 publications

References 106 publications

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Image-Guided Embolotherapy of Arteriovenous Malformations of the Face

Multicentered analysis of percutaneous sclerotherapies in venous malformations of the face

Diffusion-Weighted Imaging Prior to Percutaneous Sclerotherapy of Venous Malformations—Proof of Concept Study for Prediction of Clinical Outcome

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