Purpose or Case Report: Vascular anomalies comprise both vascular tumors and vascular malformations which can occur anywhere in the body; the trunk and extremities being the second most common location following the head and neck. Accurate identification of these anomalies is important for proper clinical evaluation and management, particularly since these patients often require multidisciplinary care. The International Society for the Study of Vascular Anomalies (ISSVA) classification, recently updated in 2014, is widely accepted and offers comprehensive classification for all medical subspecialties involved in the care of these complex anomalies, thus providing common language among caregivers. The purpose of this educational exhibit is to highlight the most important MRI and MRA imaging findings in order to identify these lesions according to the 2014 ISSVA classification.
Methods & Materials: Conventional contrast-enhanced MRI and dynamic time-resolved MRA are vital to establishing the correct diagnosis in children with vascular anomalies. In this review article, we present a state-of-the-art MRI imaging protocol with exemplary cases of the most common vascular anomalies in the trunk and extremities, using the updated 2014 ISSVA classification. In addition, we highlight common syndromes associated with these anomalies.
Results: We provide the updated 2014 ISSVA classification system, which delineates vascular anomalies into vascular tumors and vascular malformations, and those that are associated with other anomalies. Cases will highlight vascular tumors including infantile and congenital hemangiomas and vascular anomalies including lymphatic, venous and arteriovenous malformations focusing on infiltration pattern, the presence of a solid or cystic mass, identification of phleboliths, contrast enhancement pattern, and hemodynamic characteristics as it relates to proper classification. We also include examples of syndromes associated with vascular anomalies including LUMBAR syndrome, Klippel-Tranaunay syndrome, CLOVES syndrome and Kaposiform lymphangiomatosis.
Conclusions: In this exhibit we will address the most critical conventional contrast enhanced MRI and dynamic MRA features of vascular anomalies in the trunk and extremities in children following 2014 ISSVA classification. Multidisciplinary approach is crucial for these patients, thus using a common language as offered by ISSVA is essential to avoid miscommunication, misdiagnosis and delayed or inappropriate treatment.