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      Magnetic Resonance (MR) Imaging of Vascular Malformations

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          Summary

          Vascular malformations pose a diagnostic and therapeutic challenge due to the broad differential diagnosis as well as common utilization of inadequate or inaccurate classification systems among healthcare providers. Therapeutic approaches to these lesions vary based on the type, size, and extent of the vascular anomaly, necessitating accurate diagnosis and classification. Magnetic resonance (MR) imaging (MRI) is an effective modality for classifying vascular anomalies due to its ability to delineate the extent and anatomic relationship of the malformation to adjacent structures. In addition to anatomical mapping, the complete evaluation of vascular anomalies includes hemodynamic characterization. Dynamic time-resolved contrast-enhanced MR angiography provides information regarding hemodynamics of vascular anomalies, differentiating high- and low-flow vascular malformations. Radiologists must identify the MRI features of vascular malformations for better diagnosis and classification.

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          Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics.

          J Mulliken, J Glowacki (1982)
          Forty-nine specimens from a variety of vascular lesions were analyzed for cellular characteristics. Two major categories of lesions emerged from this investigation: hemangiomas and vascular malformations. This classification and its implications are justified by several considerations. Hemangiomas in the proliferating phase (n = 14) were distinguished by (1) endothelial hyperplasia with incorporation of [3H]thymidine, (2) multilaminated basement membrane formation beneath the endothelium, and (3) clinical history of rapid growth during early infancy. Hemangiomas in the involuting phase (n = 12) exhibited (1) histologic fibrosis and fat deposition, (2) low to absent [3H]thymidine labeling of endothelial cells, and (3) rapid growth and subsequent regression. The endothelium in hemangiomas had many characteristics of differentiation: Weibel-Palade bodies, alkaline phosphatase, and factor VIII production. Vascular malformations (n = 23) demonstrated no tritiated thymidine incorporation and normal ultrastructural characteristics. These lesions were usually noted at birth, grew proportionately with the child, and consisted of abnormal, often combined, capillary, arterial, venous, and lymphatic vascular elements. This cell-oriented analysis provides a simple yet comprehensive classification of vascular lesions of infancy and childhood and serves as a guide for diagnosis, management, and further research.
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            A proposed grading system for arteriovenous malformations.

            R Spetzler, N. Martin (1986)
            An important factor in making a recommendation for treatment of a patient with arteriovenous malformation (AVM) is to estimate the risk of surgery for that patient. A simple, broadly applicable grading system that is designed to predict the risk of morbidity and mortality attending the operative treatment of specific AVM's is proposed. The lesion is graded on the basis of size, pattern of venous drainage, and neurological eloquence of adjacent brain. All AVM's fall into one of six grades. Grade I malformations are small, superficial, and located in non-eloquent cortex; Grade V lesions are large, deep, and situated in neurologically critical areas; and Grade VI lesions are essentially inoperable AVM's. Retrospective application of this grading scheme to a series of surgically excised AVM's has demonstrated its correlation with the incidence of postoperative neurological complications. The application of a standardized grading scheme will enable a comparison of results between various clinical series and between different treatment techniques, and will assist in the process of management decision-making.
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              A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults.

              C Warlow, R Shahi (2001)
              By systematically reviewing the literature, we have found that there is very little information about the frequency and clinical course of arteriovenous malformations (AVMs) of the brain in adults because the methods of most studies have been flawed, and AVMs tend to be treated once they are discovered. The incidence of AVMs is approximately 1 per 100 000 per year in unselected populations, and the point prevalence in adults is approximately 18 per 100 000. AVMs account for between 1 and 2% of all strokes, 3% of strokes in young adults, 9% of subarachnoid haemorrhages and, of all primary intracerebral haemorrhages, they are responsible for 4% overall, but for as much as one-third in young adults. AVMs are far less common causes of first presentations with unprovoked seizures (1%), and of people presenting with headaches in the absence of neurological signs (0.3%). At the time of detection, at least 15% of people affected by AVMs are asymptomatic, about one-fifth present with seizures and for approximately two-thirds of them the dominant mode of presentation is with intracranial haemorrhage. The limited high quality data available on prognosis suggest that long-term crude annual case fatality is 1-1.5%, the crude annual risk of first occurrence of haemorrhage from an unruptured AVM is approximately 2%, but the risk of recurrent haemorrhage may be as high as 18% in the first year, with uncertainty about the risk thereafter. For untreated AVMs, the annual risk of developing de novo seizures is 1%. There is a pressing need for large, prospective studies of the frequency and clinical course of AVMs in well-defined, stable populations, taking account of their prognostic heterogeneity.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Pol J Radiol
                Journal ID (iso-abbrev): Pol J Radiol
                Journal ID (publisher-id): PJR
                Title: Polish Journal of Radiology
                Publisher: Termedia Publishing House
                ISSN (Print): 1733-134X
                ISSN (Electronic): 1899-0967
                Publication date (Electronic): 15 December 2017
                Publication date Collection: 2017
                Volume: 82
                Pages: 731-741
                Affiliations
                [1 ]Division of Imaging Research and Biomedical, Engineering, St. Thomas’ Hospital, London, ON, Canada
                [2 ]Department of Diagnostic Radiology, Geisinger Medical Center, Danville, PA, U.S.A
                [3 ]Division of Emergency and Trauma Radiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
                [4 ]Department of Diagnostic Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
                Author notes
                Author’s address: Faisal Khosa, Department of Radiology, Vancouver General Hospital, 899 12th Avenue W, Vancouver, BC, Canada, V5Z 1M9, e-mail: fkhosa@ 123456gmail.com
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                [*]

                Drs’ Usman Bashir and Samd Shah contributed equally to this work

                [#]

                Dr. Khosa is a Canadian Association of Radiologists leadership scholar (2017)

                Article
                Publisher ID: 903491
                DOI: 10.12659/PJR.903491
                PMC ID: 5894044
                PubMed ID: 29657639
                SO-VID: 5ac829a9-a550-44bf-9f17-708be958aba4
                Copyright © Copyright © Polish Medical Society of Radiology 2017
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                History
                Date received : 22 January 2017
                Date accepted : 05 March 2017
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: congenital abnormalities,magnetic resonance angiography,magnetic resonance imaging,vascular malformations
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: congenital abnormalities, magnetic resonance angiography, magnetic resonance imaging, vascular malformations

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