title: Multimodality Image-Guided Sclerotherapy of Low-Flow Orbital Vascular Malformations: Report of Single-Center Experience.
abstract: OBJECTIVE
  To evaluate the role of multimodality imaging tools for intraprocedural guidance and outcome evaluation during sclerotherapy of low-flow orbital vascular malformations.
  
  
  METHODS
  A retrospective review was performed of 17 consecutive patients with low-flow orbital malformations (14 lymphatic, two venous, and one venolymphatic) who underwent multimodality image-guided sclerotherapy between November 2012 and May 2015. Sclerotherapy technique, image guidance tools, and complications were recorded. Sclerotherapy outcome was evaluated using clinical response, magnetic resonance (MR) image-based lesion volumetry, and proptosis quantification.
  
  
  RESULTS
  There were 22 sclerotherapy sessions performed. Intraprocedural ultrasound (US), fluoroscopy, cone-beam computed tomography (CT) and MR image fusion were used for image guidance with 100% technical success. Resolution of presenting symptoms was observed in all patients at 1-month follow-up. Four major sclerotherapy complications were successfully managed. Statistically significant reduction in lesion volume (P = .001) and proptosis (P = .0117) by MR image analysis was achieved in all patients in whom 3-month follow-up MR imaging was available (n = 13/17). There was no lesion recurrence at a median follow-up of 18 months (range, 8-38 mo).
  
  
  CONCLUSIONS
  Multimodality imaging tools, including US, fluoroscopy, cone-beam CT, and MR fusion, during sclerotherapy of low-flow orbital malformations provide intraprocedural guidance and quantitative image-based evaluation of treatment outcome.
authors.affiliation: Department of Radiology, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Samer
authors.initials: S
authors.lastname: Harmoush
authors.affiliation: Angiography Division, Siemens Medical Solutions USA, Inc, Hoffman Estates, Illinois.
authors.forename: Ponraj
authors.initials: P
authors.lastname: Chinnadurai
authors.affiliation: Department of Radiology, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Kamel
authors.initials: K
authors.lastname: El Salek
authors.affiliation: Department of Radiology, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Zeyad
authors.initials: Z
authors.lastname: Metwalli
authors.affiliation: Department of Ophthalmology, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Honey
authors.initials: H
authors.lastname: Herce
authors.affiliation: Department of Ophthalmology, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Amit
authors.initials: A
authors.lastname: Bhatt
authors.affiliation: Department of Radiology, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Paul
authors.initials: P
authors.lastname: Steinkuller
authors.affiliation: Department of Pediatric Pulmonology, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Timothy
authors.initials: T
authors.lastname: Vece
authors.affiliation: Department of Pediatric Anesthesia, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, , Houston, Texas.
authors.forename: Shakeel
authors.initials: S
authors.lastname: Siddiqui
authors.affiliation: Department of Division of Pediatric Surgery, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, , Houston, Texas.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Pimpalwar
authors.affiliation: Department of Pediatric Oculofacial Surgery, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, , Houston, Texas.
authors.forename: Douglas
authors.initials: D
authors.lastname: Marx
authors.affiliation: Department of Radiology, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Michel
authors.initials: M
authors.lastname: Mawad
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Texas Children's Hospital, 6621 Fannin Street, Houston, TX 77030.. Electronic address: ashwinsheena@hotmail.com.
authors.forename: Sheena
authors.initials: S
authors.lastname: Pimpalwar
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D054893:Cone-Beam Computed Tomography; D005094:Exophthalmos / Q000209:etiology; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D064847:Multimodal Imaging / Q000379:methods*; D009915:Orbit / Q000098:blood supply*; D011237:Predictive Value of Tests; D015641:Radiography, Interventional / Q000379:methods*; D012039:Regional Blood Flow; D012189:Retrospective Studies; D015911:Sclerotherapy / Q000009:adverse effects / Q000379:methods*; D013781:Texas; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D054079:Vascular Malformations / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult