Differentiation of vascular birthmarks by MR imaging. An investigation of hemangiomas, venous and lymphatic malformations.
OBJECTIVE
To evaluate the use of MR imaging using standard sequences in the differentiation of common vascular birthmarks of soft tissues in childhood.


METHODS
Forty-three lesions in 37 children (median age 33 months) with hemangiomas (n=25), venous (n=8) and lymphatic (n=10) malformations were retrospectively studied. Images were obtained with a 0.2 T and a 1.5 T MR unit, using T1-weighted spin-echo, T2-weighted turbo spin-echo and turbo STIR sequences. In addition, 19 contrast studies were evaluated. Signal intensities and morphological characteristics were analyzed.


RESULTS
All hemangiomas were hyperintense in T2-weighted, and mostly (22/25) isointense compared to the surrounding skeletal muscle in T1-weighted images. The lesions were homogeneous or mildly inhomogeneous and well defined. Venous and lymphatic malformations showed similar patterns. Contrary to other lesions, no vessels or lobular architecture were detectable and contrast enhancement was absent in lymphatic malformations.


CONCLUSIONS
A reliable differentiation between hemangiomas, venous and lymphatic malformations in childhood is not possible by standard MR sequences alone. Contrast media may be helpful as lymphatic malformations show no contrast enhancement. The main role of MR imaging is to determine the local extent or infiltration of deeper tissue layers and narrow the differential diagnosis of other soft tissue tumors.
Kern
S
S
Department of Diagnostic Radiology, University Hospital, Freiburg, Germany.
Niemeyer
C
C
Darge
K
K
Merz
C
C
Laubenberger
J
J
Uhl
M
M
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D019786:Gadolinium DTPA; D006391:Hemangioma / Q000175:diagnosis*; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008221:Lymphoid Tissue / Q000002:abnormalities*; D008279:Magnetic Resonance Imaging; D008297:Male; D018482:Muscle, Skeletal / Q000473:pathology; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012867:Skin / Q000098:blood supply*; D012868:Skin Abnormalities / Q000175:diagnosis*; D012878:Skin Neoplasms / Q000175:diagnosis*; D012983:Soft Tissue Neoplasms / Q000175:diagnosis; D014680:Veins / Q000002:abnormalities
D003287:Contrast Media; D019786:Gadolinium DTPA