The correct diagnostic classification of a vascular anomaly  (ISSVA classification) is essential because therapeutic strategies are differentiated. In addition to medical history and physical examination, radiological imaging plays a vital role in the differential diagnostic work-up of vascular anomalies. The imaging techniques used include sonography, magnetic resonance imaging (MRI), digital subtraction angiography (DSA), phlebography/varicography, conventional X-rays and computed tomography (CT).

Characteristics of the different imaging techniques

  • Widely available
  • Classification of vascular anomalies in many cases possible
  • Operator dependent
  • Relatively small field of view
  • Limited penetration depth
Magnetic resonance imaging (MRI)
  • Good soft tissue contrast
  • Best differential diagnosis
  • Gold standard in the evaluation of vascular anomalies
  • Joint assessment
  • Long examination times (therefore anesthesia necessary in infants and young children)
  • Claustrophobic
Digital subtraction angiography (DSA)
  • Standard in therapy planning and implementation in fast-flow vascular malformations
  • Extremely high temporal und spatial resolution
  • Radiation exposure
    Percutaneous arterial access required (pressure dressing))
  • Standard imaging modality during therapy of venous malformations (sclerotherapy)
  • Radiation exposure
  • Puncture necessary
Conventional radiography
  • Assessment of bones and articular structures
  • Imaging of phleboliths (pathognomonic for venous malformations)
  • Assessment of soft tissues not possible
  • Radiation exposure
Computed tomography (CT)
  • Imaging of large vessels (e.g., lung, aorta)
  • Assessment of bones and joints
  • Good spatial resolution
  • Fast (few motion artifacts)
  • Radiation exposure
  • Relatively poor soft tissue contrast
  • Artifacts after invasive therapy (e.g. coils, plugs)