Multidetector CT angiography of pediatric vascular malformations and hemangiomas: utility of 3-D reformatting in differential diagnosis.
BACKGROUND
Vascular malformations can be difficult to diagnose and classify. Accurate classification is important because treatments and prognosis vary based on the type of lesion. Diagnosis is based on a combination of clinical features with a variety of imaging techniques, including US, MRI/MRA, CT, and conventional angiography.


OBJECTIVE
We hypothesized that imaging features seen on 3-D reformatted images obtained with multidetector CT angiography (CTA) would aid in differential diagnosis of types of vascular anomalies.


METHODS
We retrospectively reviewed CT scans of 11 patients with vascular lesions and pathologically proven diagnoses in which 3-D reformatting was obtained.


RESULTS
The 3-D images accurately diagnosed hemangiomas and lymphangiomas in all cases, in contrast to diagnosis by clinical criteria and planar CT, which was difficult or inaccurate. The 3-D CTA did not aid in the distinction between venous malformations and arteriovenous malformations (AVM), which appeared similar.


CONCLUSIONS
Our preliminary observations suggest that volume-rendered reformatting is helpful in categorizing clinically significant vascular head and neck lesions, resulting in more diagnostic value than planar CT imaging alone. In particular, 3-D CTA might allow accurate differentiation of hemangiomas from AVM, and of lymphangiomas from other types of lesions, which was, in our series, not possible using clinical examination or conventional planar CT angiography.
Bittles
Mark A
MA
Department of Radiology, University of Washington School of Medicine, 1959 NE Pacific, P.O. Box 357115, Seattle, WA 98195, USA. mbittles@u.washington.edu
Sidhu
Manrita K
MK
Sze
Raymond W
RW
Finn
Laura S
LS
Ghioni
Victor
V
Perkins
Johnathan A
JA
D000293:Adolescent; D020785:Central Nervous System Vascular Malformations / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000295:instrumentation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging*; D006391:Hemangioma / Q000000981:diagnostic imaging*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000295:instrumentation / Q000379:methods*; D007223:Infant; D008297:Male; D011379:Prognosis; D011856:Radiographic Image Enhancement / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods