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Venous Vascular Malformations in Pediatric Patients: Comparison of Results of Alcohol Sclerotherapy with Proposed MR Imaging Classification¹

¹ From the Department of Medical Imaging/Neuroradiology, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. From the 2000 RSNA scientific assembly. Received June 4, 2001; revision requested January 17; final revision received October 1; accepted October 16. Address correspondence to D.A. (e-mail: derek.armstrong@sickkids.on.ca).

PURPOSE: To compare the clinical results of percutaneous sclerotherapy of venous vascular malformations (VVMs) with the authors’ proposed magnetic resonance (MR) imaging classification.

MATERIALS AND METHODS: MR findings and clinical results of percutaneous alcohol sclerotherapy in 59 pediatric patients with VVMs were retrospectively reviewed. Before treatment, lesions were graded with MR imaging on the basis of margins and size, respectively: grade 1, well defined, less than or equal to 5 cm; grade 2A, well defined, greater than 5 cm; grade 2B, ill defined, less than or equal to 5 cm; and grade 3, ill defined, greater than 5 cm. Regression models were used to test trends in therapy across the MR classification grades, including the repeat sclerotherapies, volumes of ethanol and metrizamide administered for each lesion, and number of access sites. Clinical response to sclerotherapy, which was evaluated with consensus by a multidisciplinary team, was graded as poor, good, or excellent. Association between MR imaging grade and clinical assessment was tested with the Fisher exact test.

RESULTS: There were 14 grade 1 lesions, nine grade 2A, 15 grade 2B, and 21 grade 3. Twenty-four patients had a poor response to sclerotherapy; 19, good; and 16, excellent. Ten of 14 (71%) grade 1 lesions had an excellent response; none, a poor response. Twelve of 21 (57%) grade 3 lesions had a poor response; none, an excellent result. Grade 2 lesions were relatively equally distributed among the three categories, with the exception of nine of 15 (60%) grade 2B lesions that had a poor response (P < .001). There was a trend with increasing lesion grade for increasing numbers of sclerotherapy sessions, volumes of ethanol and metrizamide for each lesion, and numbers of access sites.

CONCLUSION: There is a strong association between this proposed MR imaging classification and the results of percutaneous sclerotherapy.

© RSNA, 2002

Index terms: Alcohol, 9_*.1264², 9_*.759 • Arteriovenous malformations, 9_*.1264, 9_*.759 • Interventional procedures, in infants and children, 9_*.1264, 9_*.759 • Veins, malformations, 9_*.1264, 9_*.759 • Veins, therapeutic embolization, 9_*.1264, 9_*.759

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