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Soft-Tissue Venous Malformations in Adult Patients: Imaging and Therapeutic Issues¹

¹ From the Department of Radiology, Ste-Justine Hospital, 3175 Côte Ste-Catherine, Montréal, Québec, Canada H3T 1C5 (J.D., C.L.); and the Department of Radiology, Centre Hospitalier de l’Université de Montréal, Québec, Canada (G.S., V.L.O., M.J.B., E.T.). Recipient of a Magna Cum Laude award for an education exhibit at the 2000 RSNA scientific assembly. Received February 27, 2001; revision requested May 2 and received June 28; accepted July 2. Address correspondence to J.D. (e-mail: joseedubois@compuserve.com).

Venous malformations are the most common vascular malformations. However, confusion with respect to terminology and imaging guidelines continues to result in improper diagnosis and treatment. An appropriate classification scheme for vascular anomalies is important to avoid the use of false generic terms. Adequate imaging in association with clinical findings is crucial to establishing the correct diagnosis. Doppler ultrasonography should be the initial imaging modality and demonstrates absence of flow or low-velocity venous flow. Computed tomography and magnetic resonance (MR) imaging are used primarily for pretreatment evaluation of lesion extension. These lesions are usually hypointense on T1-weighted MR images and markedly hyperintense on T2-weighted images with variable gadolinium enhancement. Direct phlebography helps confirm the diagnosis and exclude other soft-tissue tumors. Three distinct phlebographic patterns (cavitary, spongy, dysmorphic) have been identified. In most cases, conservative treatment is recommended. Sclerotherapy with or without surgery is useful in cases of functional impairment or significant aesthetic prejudice, even if recurrences are frequent. Direct phlebography is performed when a more detailed assessment of the vascular pattern is needed or as part of sclerotherapy. Use of the appropriate imaging technique is critical in establishing the diagnosis, evaluating extension, and planning appropriate treatment.

Index Terms: Arteriovenous malformations, 9*.142² • Arteriovenous malformations, therapeutic radiology, 9*.124, 9*.1291, 9*.12941, 9*.12984 Veins, abnormalities, 9*.142

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