Imaging

Chapter: Imaging
Article: 1 of 10
Update: Feb 05, 2021
Author(s): Müller-Wille, René

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

Procedure	Description	Disadvantages
Sonography	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))
Phlebography/varicography	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)

Which imaging modality is used when and where in the diagnosis of vascular malformations and vascular tumors? What are typical findings?
In addition to clinical examination, diagnostic imaging plays a central role in the differential diagnostic work-up of vascular anomalies. Among the imaging techniques used are

Sonography
Magnetic resonance imaging (MRI)
Digital subtraction angiography (DSA)
Phlebography/varicography
Conventional radiography
Computed tomography (CT)
Lymphography

Besides the diagnostic aspect, intraoperative imaging is now an important tool in the context of minimally invasive procedures. The chapter on imaging illustrates these methods as well as the indications, advantages and drawbacks, and shows typical findings in computed tomography, magnetic resonance imaging (MRI) and sonography for vascular anomalies.

Compendium Vascular Anomalies

Find scientific articles and clinical cases on vascular malformations and vascular tumors

Imaging

Characteristics of the different imaging techniques

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Imaging

Corresponding patient examples

Venous malformation of the abdomen during pregnancy

Large, deep-seated infantile hemangioma

Large arteriovenous malformation of the cheek

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