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      Role of dynamic contrast-enhanced magnetic resonance imaging in the diagnosis and management of vascular lesions of the head and neck

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          Abstract

          Vascular anomalies comprise a wide and heterogeneous group of lesions that may be found in all parts of the body, with most of the cases of vascular malformations involving the head-and-neck region. Ultrasound (US) is the reliable first-line imaging technique to assess flow parameters. However, in some cases, US fails to depict the real extent of the lesions. On the other hand, magnetic resonance imaging (MRI) allows the evaluation of the full extension and anatomic relationship of the vascular anomalies with the neighboring structures and provides hemodynamic characterization using dynamic contrast-enhanced MRI (DCE-MRI), avoiding unnecessary invasive catheter-based procedures. DCE-MRI angiography can make a distinction between low- and high-flow vascular anomalies and it is useful for selecting adequate therapy and appreciating prognosis. The aim of this paper is to review the role of DCE-MRI in the evaluation of flow characteristics and lesion extent in vascular anomalies of the head-and-neck region.

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

          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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            Vascular malformations and hemangiomas: a practical approach in a multidisciplinary clinic.

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              MR imaging of soft-tissue vascular malformations: diagnosis, classification, and therapy follow-up.

              Vascular malformations and tumors comprise a wide, heterogeneous spectrum of lesions that often represent a diagnostic and therapeutic challenge. Frequent use of an inaccurate nomenclature has led to considerable confusion. Since the treatment strategy depends on the type of vascular anomaly, correct diagnosis and classification are crucial. Magnetic resonance (MR) imaging is the most valuable modality for classification of vascular anomalies because it accurately demonstrates their extension and their anatomic relationship to adjacent structures. A comprehensive assessment of vascular anomalies requires functional analysis of the involved vessels. Dynamic time-resolved contrast material-enhanced MR angiography provides information about the hemodynamics of vascular anomalies and allows differentiation of high-flow and low-flow vascular malformations. Furthermore, MR imaging is useful in assessment of treatment success and establishment of a long-term management strategy. Radiologists should be familiar with the clinical and MR imaging features that aid in diagnosis of vascular anomalies and their proper classification. Furthermore, they should be familiar with MR imaging protocols optimized for evaluation of vascular anomalies and with their posttreatment appearances. Supplemental material available at http://radiographics.rsna.org/lookup/suppl/doi:10.1148/rg.315105213/-/DC1.
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                Author and article information

                Journal
                Bosn J Basic Med Sci
                Bosn J Basic Med Sci
                Bosnian Journal of Basic Medical Sciences
                Association of Basic Medical Sciences of Federation of Bosnia and Herzegovina (Bosnia )
                1512-8601
                1840-4812
                April 2022
                19 August 2021
                : 22
                : 2
                : 156-163
                Affiliations
                [1 ]Department of Radiology and Medical Imaging, County Clinical Emergency Hospital, Cluj-Napoca, Romania
                [2 ]Department of Radiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
                [3 ]Department of Cranio-Maxillofacial Surgery, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
                [4 ]Department of Maxillofacial Surgery and Implantology, Faculty of Dentistry, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
                [5 ]Department of Cranio-Maxillofacial Surgery and Radiology, Faculty of Dental Medicine, “Iuliu Hațieganu” University Of Medicine and Pharmacy Cluj-Napoca, Romania
                [6 ]Department of Dermatology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
                Author notes
                [* ] Corresponding author: Manuela Lenghel, Department of Radiology, Faculty of Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. E-mail: lenghel.manuela@ 123456gmail.com
                Article
                BJBMS-22-156
                10.17305/bjbms.2021.6019
                8977080
                34420512
                a9238ccb-aa53-4e31-b28d-27626c56cf67
                Copyright: © The Author(s) (2022)

                This work is licensed under a Creative Commons Attribution 4.0 International License

                History
                : 09 May 2021
                : 02 August 2021
                Categories
                Review Article

                vascular malformation,dynamic contrast-enhanced magnetic resonance,head and neck,hemangioma,post-therapeutic evaluation

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