What are the Appropriate Diagnostic Tests?

                          Click here to see review article (Cleveland Clinic Journal of Medicine)

Most vascular birthmarks can be diagnosed without imaging studies. However, imaging (particularly MRI) is needed in most symptomatic patients to confirm the suspected diagnosis and to evaluate the extent of the lesion (hemangioma, arteriovenous malformation or AVM, venous malformation, lymphatic malformation, cystic hygroma etc.). In addition to making the diagnosis, MRI plays a major role in decision making regarding how these lesions need to be treated (surgery versus embolization/sclerotherapy).

Magnetic Resonance Angiography (MRA) and Magnetic Resonance Venography (MRV) can be performed simultaneously with MRI and can supply additional information on the vascularity of the vascular birthmark lesion. Overall, the treatment method (e.g., surgery versus embolization or sclerotherapy) is generally selected based on the imaging findings. 

MR scanning needs to be performed using a dedicated imaging protocol, which includes injecting intravenous contrast material during the scan, to make an accurate diagnosis and to fully map out the vasculature of the lesion.

Unfortunately, inadequate MR scanning is commonly performed across the country and most of these scans are interpreted by inexperienced physicians. Also, catheter arteriography (an invasive diagnostic test) is unnecessarily performed on many patients. In some patients, Doppler US examinations are adequate for diagnostic testing. CT and x-ray imaging have a limited role in vascular anomalies/birthmarks. On the other hand, new multi-detector CT scanners may be used for vascular imaging (Computed tomographic angiography or CTA) in selected patients, particularly in patients with high flow vascular birthmarks (AVM, hemangioma, arteriovenous fistula or AVF). 

It is important to obtain the appropriate imaging study, and to obtain an interpretation from an experienced radiologist or interventional radiologist to make an accurate diagnosis, which will eventually change the direction of the therapeutic approach.


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