The new role of magnetic resonance imaging in the contemporary diagnosis of venous malformation: can it replace angiography?
BACKGROUND
Magnetic resonance imaging (MRI) is well accepted for the contemporary diagnosis of venous malformation (VM), providing hemodynamic and anatomic information on the lesion, including its relationship with surrounding tissues and organs.


METHODS
A total of 196 clinically suspected VM patients were reviewed retrospectively to assess the accuracy and reliability of MRI for the diagnosis of VM. Initial workup included MRI, duplex ultrasonography, and whole-body blood pool scintigraphy, along with additional transarterial lung perfusion scintigraphy and lymphoscintigraphic assessment when indicated. Phlebography or arteriography, or both, were generally reserved as a road map for the treatment. A total of 294 MRI findings for 196 patients were also compared with the matching duplex ultrasonography findings available for 178 patients and matching whole-body blood pool scintigraphy findings for 136 patients. The phlebographic findings available for 87 patients were also compared.


RESULTS
Among the 196 patients with clinically suspected VM, 174 were confirmed as having VM by MRI with true-positive findings and 2 as false-positive findings by MRI (sensitivity, 98.9%; positive predictive value, 98.9%). MRI ruled out VM for 18 patients with true-negative findings, though 2 were false-negative (specificity, 90%; negative predictive value, 90.0%). Two positive and two false-negative findings of VM, made by MRI, were subsequently confirmed by angiography. Among the 87 patients for whom phlebographic findings were available, 73 were confirmed as true-positive diagnoses of VM, 1 as false-positive, 11 as true-negative, and 2 as false-negative (sensitivity, 97.3%; specificity, 91.7%; positive predictive value, 98.7%; negative predictive value, 84.6%).


CONCLUSIONS
MRI is likely to modify the traditional role of angiography for the management of VM and become a new standard, at least for diagnosis. MRI also is an excellent parameter in the assessment of treatment results.
Lee
Byung-Boong
BB
Department of Surgery, Sungkyunkwan University School of Medicine and Samsung Medical Center, Seoul, South Korea.
Choe
Yeon Hyeon
YH
Ahn
Joong Mo
JM
Do
Young Soo
YS
Kim
Dong-Ik
DI
Huh
Seo Ho
SH
Byun
Hong Sik
HS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D018376:Cardiovascular Abnormalities / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014680:Veins / Q000002:abnormalities*