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Hemangiomas in the Face and Extremities: MR–guided Sclerotherapy—Optimization with Monitoring of Signal Intensity Changes in Vivo¹

¹ From the Departments of Radiology (N.H., T.M., T.O, O.A., S.A., K.O.) and Plastic Surgery (N.K., K.T.), Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Received January 14, 2002; revision requested March 5; revision received June 3; accepted July 1. Address correspondence to N.H. (e-mail: naoto-tky@umin.ac.jp).

View larger version (23K): [in a new window]   Figure 1. Schematic shows relationship between concentration of gadopentetate dimeglumine and SI of blood doped with the contrast agent. In the Equation, N(H) = 1, F(V) = 1, TR = 5.0 sec, TE = 0.1 sec, T1d = 1.5 sec, T2d = 1.5 sec, R1 = 5 mmol-1 · sec-1, and R2 = 5 mmol-1 · sec-1). The SI of blood doped with gadopentetate dimeglumine changes within a relatively narrow concentration range and is virtually 0 above a certain concentration.

View larger version (20K): [in a new window]   Figure 2a. Schematic shows test and sclerosant injections guided with MR fluoroscopy. (a) FISP MR fluoroscopic imaging. Left: Lesion is isointense. Middle: One percent gadopentetate dimeglumine is hyperintense against isointense lesion. Right: Fully injected lesion is hyperintense against surrounding soft-tissue structures. (b) PSIF MR fluoroscopic imaging. Left: Lesion is hyperintense. Middle: EO-gadopentetate dimeglumine mixture is hypointense against hyperintense lesion. Right: When effective concentration is achieved, lesion is signal void.

View larger version (21K): [in a new window]   Figure 2b. Schematic shows test and sclerosant injections guided with MR fluoroscopy. (a) FISP MR fluoroscopic imaging. Left: Lesion is isointense. Middle: One percent gadopentetate dimeglumine is hyperintense against isointense lesion. Right: Fully injected lesion is hyperintense against surrounding soft-tissue structures. (b) PSIF MR fluoroscopic imaging. Left: Lesion is hyperintense. Middle: EO-gadopentetate dimeglumine mixture is hypointense against hyperintense lesion. Right: When effective concentration is achieved, lesion is signal void.

View larger version (81K): [in a new window]   Figure 3a. MR fluoroscopic images of test samples (eight test tubes) of various gadopentetate dimeglumine concentrations were obtained with (a) FISP (18/8; flip angle, 90°) and (b) PSIF (22/10; flip angle, 90°) MR fluoroscopic sequences. Top row, left to right: Test samples with 10.0%, 1.0%, 0.1%, and 0.01% gadopentetate dimeglumine. Bottom row, left to right: Test samples with 75% ethanol, water, 0.001% gadopentetate dimeglumine, and 0.0001% gadopentetate dimeglumine. In a, 1% gadopentetate dimeglumine solution has highest SI. In b, 10% gadopentetate dimeglumine solution is signal void, while other concentrations show some SI.

View larger version (102K): [in a new window]   Figure 3b. MR fluoroscopic images of test samples (eight test tubes) of various gadopentetate dimeglumine concentrations were obtained with (a) FISP (18/8; flip angle, 90°) and (b) PSIF (22/10; flip angle, 90°) MR fluoroscopic sequences. Top row, left to right: Test samples with 10.0%, 1.0%, 0.1%, and 0.01% gadopentetate dimeglumine. Bottom row, left to right: Test samples with 75% ethanol, water, 0.001% gadopentetate dimeglumine, and 0.0001% gadopentetate dimeglumine. In a, 1% gadopentetate dimeglumine solution has highest SI. In b, 10% gadopentetate dimeglumine solution is signal void, while other concentrations show some SI.

View larger version (149K): [in a new window]   Figure 4. Fast spin-echo T2-weighted MR images (5,000/102; echo train length, seven) depict test samples (17 test tubes) with various gadopentetate dimeglumine concentrations diluted with blood. Top row: 8%/5% (gadopentetate dimeglumine/EO) solution; left to right, 100.0%, 50.0%, 25.0%, 12.5%, 6.3% dilutions. Second row: 4%/5% solution; left to right, 100.0%, 50.0%, 25.0%, 12.5%, 6.3% dilutions. Third row: 2%/5% solution; left to right, 100.0%, 50%.0, 25.0%, 12.5%, 6.3% dilutions. Bottom row: 1%/5% solution; left to right, 100.0%, 50.0%, 25.0%, 12.5%, 6.3% dilutions; far right, one-sample control (water). With the 8%/5% solution, changes in SI from signal void to some SI occur at a concentration between 25.0% and 12.5% (arrows); the six samples on the left do not show any SI.

View larger version (57K): [in a new window]   Figure 5a. MR images depict MR-guided sclerotherapy of a hemangioma in the upper lip of a 24-year-old woman. (a) Midsagittal FISP MR fluoroscopic image (21/10; flip angle, 90°; matrix size, 64 x 128; field of view, 200 x 200 mm; section thickness, 8 mm; acquisition time, 2 seconds per image [from right to left]). (b) Midsagittal PSIF MR fluoroscopic image (22/10; flip angle, 90°; matrix size, 64 x 128; field of view, 200 x 200 mm; section thickness, 8 mm; acquisition time, 2 seconds per image [from right to left]). In a, lesion (arrow) shows increasing SI after test injection of gadopentetate dimeglumine. In b, lesion (arrow) shows expansion of hypointense area after injection of sclerosant mixture; hypointensity of sclerosant mixture contrasts well against hyperintensity of surrounding lesion. (c, d) Transverse fast spin-echo T2-weighted MR images (5,000/102; echo train length, seven; matrix size, 196 x 256; field of view, 150 x 200; section thickness, 5 mm; two signals acquired) were obtained (c) before sclerotherapy and (d) immediately after sclerotherapy. Hyperintense lesion (arrow) in upper lip becomes signal void after sclerotherapy, which indicates adequate sclerosant concentration in vivo.

View larger version (72K): [in a new window]   Figure 5b. MR images depict MR-guided sclerotherapy of a hemangioma in the upper lip of a 24-year-old woman. (a) Midsagittal FISP MR fluoroscopic image (21/10; flip angle, 90°; matrix size, 64 x 128; field of view, 200 x 200 mm; section thickness, 8 mm; acquisition time, 2 seconds per image [from right to left]). (b) Midsagittal PSIF MR fluoroscopic image (22/10; flip angle, 90°; matrix size, 64 x 128; field of view, 200 x 200 mm; section thickness, 8 mm; acquisition time, 2 seconds per image [from right to left]). In a, lesion (arrow) shows increasing SI after test injection of gadopentetate dimeglumine. In b, lesion (arrow) shows expansion of hypointense area after injection of sclerosant mixture; hypointensity of sclerosant mixture contrasts well against hyperintensity of surrounding lesion. (c, d) Transverse fast spin-echo T2-weighted MR images (5,000/102; echo train length, seven; matrix size, 196 x 256; field of view, 150 x 200; section thickness, 5 mm; two signals acquired) were obtained (c) before sclerotherapy and (d) immediately after sclerotherapy. Hyperintense lesion (arrow) in upper lip becomes signal void after sclerotherapy, which indicates adequate sclerosant concentration in vivo.

View larger version (124K): [in a new window]   Figure 5c. MR images depict MR-guided sclerotherapy of a hemangioma in the upper lip of a 24-year-old woman. (a) Midsagittal FISP MR fluoroscopic image (21/10; flip angle, 90°; matrix size, 64 x 128; field of view, 200 x 200 mm; section thickness, 8 mm; acquisition time, 2 seconds per image [from right to left]). (b) Midsagittal PSIF MR fluoroscopic image (22/10; flip angle, 90°; matrix size, 64 x 128; field of view, 200 x 200 mm; section thickness, 8 mm; acquisition time, 2 seconds per image [from right to left]). In a, lesion (arrow) shows increasing SI after test injection of gadopentetate dimeglumine. In b, lesion (arrow) shows expansion of hypointense area after injection of sclerosant mixture; hypointensity of sclerosant mixture contrasts well against hyperintensity of surrounding lesion. (c, d) Transverse fast spin-echo T2-weighted MR images (5,000/102; echo train length, seven; matrix size, 196 x 256; field of view, 150 x 200; section thickness, 5 mm; two signals acquired) were obtained (c) before sclerotherapy and (d) immediately after sclerotherapy. Hyperintense lesion (arrow) in upper lip becomes signal void after sclerotherapy, which indicates adequate sclerosant concentration in vivo.

View larger version (128K): [in a new window]   Figure 5d. MR images depict MR-guided sclerotherapy of a hemangioma in the upper lip of a 24-year-old woman. (a) Midsagittal FISP MR fluoroscopic image (21/10; flip angle, 90°; matrix size, 64 x 128; field of view, 200 x 200 mm; section thickness, 8 mm; acquisition time, 2 seconds per image [from right to left]). (b) Midsagittal PSIF MR fluoroscopic image (22/10; flip angle, 90°; matrix size, 64 x 128; field of view, 200 x 200 mm; section thickness, 8 mm; acquisition time, 2 seconds per image [from right to left]). In a, lesion (arrow) shows increasing SI after test injection of gadopentetate dimeglumine. In b, lesion (arrow) shows expansion of hypointense area after injection of sclerosant mixture; hypointensity of sclerosant mixture contrasts well against hyperintensity of surrounding lesion. (c, d) Transverse fast spin-echo T2-weighted MR images (5,000/102; echo train length, seven; matrix size, 196 x 256; field of view, 150 x 200; section thickness, 5 mm; two signals acquired) were obtained (c) before sclerotherapy and (d) immediately after sclerotherapy. Hyperintense lesion (arrow) in upper lip becomes signal void after sclerotherapy, which indicates adequate sclerosant concentration in vivo.