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.