Article Figures & Data
Figures
- Fig 1.
Early (A), mid (B), and late (C) phase direct needle puncture phlebography of a left facial venous malformation by using a traditional digital subtraction angiography technique shows appropriate needle localization for subsequent embolization. There is satisfactory sequential opacification of the venous channels of the lesion (arrow) and only faint flow into small draining veins (arrowheads), with no evidence of contrast extravasation or demonstration of large draining veins.
- Fig 2.
A 36-year-old man with a left facial venous malformation who undergone 14 treatments during the past 3 years, the last 2 with MR imaging guidance. Overview of the direct-injection MR angiography technique for embolization of the lesion. A, Patient photograph before MR sclerotherapy shows left facial swelling from a persistent left facial venous malformation. Coronal (B) and axial (C) T2-weighted fat-saturated MR images demonstrate the typical imaging characteristics of a venous vascular malformation, including a mixed signal intensity but mostly bright trans-spatial lesion extending both superficial and deep to the left mandible composed of multiloculated blood-filled channels with fluid-fluid levels producing local mass effect. Pretreatment MR angiograms, early (D) and late (E) phase, show appropriate needle positioning within the loculated blood-filled channels of the venous malformation (arrow) with slow venous runoff into a small draining vein (arrowheads). Posttreatment MR angiograms, early (F) and late (G) phase, demonstrate pruning of the vascular channels of the venous malformation with markedly diminished flow into the draining vein, compatible with satisfactory embolization of the lesion.
- Fig 3.
A 6-year-old boy with a peripheral venous malformation of the left knee. Note depiction of the mask subtraction technique that results in more complete visualization of the vascular structures on MR angiography. Coronal (A) and axial (B) T2-weighted fat-saturated MR images demonstrate a multiloculated increased T2-signal venous vascular malformation in the left knee, particularly surrounding the medial and posterior portions of the distal femur. Pretreatment MR angiogram, without (C) and with (D) digital mask subtraction, shows opacification of the venous malformation but limited visualization of the draining vein (arrowheads) without mask subtraction; however, there is not only improved visualization of the venous malformation but also excellent visualization of the draining vein (arrowheads) achieved following mask subtraction of the images. E, Posttreatment MR angiogram again shows pruning of the vascular channels of the venous malformation with no significant flow into the draining vein, compatible with satisfactory embolization of the lesion.
- Fig 4.
A 10-year-old girl with a very large venous malformation of the right face, who has had >20 previous treatment episodes with traditional digital subtraction angiography guidance, now being treated with MR imaging guidance. These images demonstrate the necessity of angiography to assure proper needle positioning. Coronal (A) and axial (B) T2-weighted fat-saturated MR images show the very large venous vascular malformation extending essentially throughout all superficial and deep spaces of the right face, producing significant local mass effect. C, Pretreatment MR angiogram, initial needle placement, demonstrates opacification of the venous malformation but also a focus of stagnation of contrast material that remained on the late-phase images, indicating extravasation (arrow). Thus, this is not a safe location to treat, and sclerotherapy was not performed. Note that normal venous backflow from the needle hub was initially detected, but adequate needle placement can only be assured following angiography. Early (D) and late (E) phase pretreatment MR angiograms, second needle placement, again demonstrate opacification of the venous malformation but now also show runoff of the contrast material on the late-phase image, indicating safe needle placement for embolization (arrowheads). Note the continued presence of the previously extravasated contrast material from the first injection on this nonmask subtracted image (arrows). F, Early-phase pretreatment MR angiogram, third needle placement, depicts needle localization within the venous malformation; however, there is very rapid filling of an enlarged draining vein (arrow). Thus, this is not a safe location to treat, and sclerotherapy was not performed. Again, adequate needle placement can only be assured following angiographic visualization of the lesion. Patient photographs before (G) and following (H) MR sclerotherapy show significant improvement in right facial swelling; however, a persistent right facial venous malformation is still present, requiring additional multiple future treatment sessions.
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