Abstract
Vascular anomalies are a diverse group of pathologic conditions. They have different manifestations, natural histories, and treatments. Compared with other vascular malformations, arteriovenous malformations (AVMs) are considered the most symptomatic and difficult to manage. AVMs inherently progress and have a high rate of recurrence after treatment. Imaging helps provide an accurate and early diagnosis, which can then be used to direct appropriate management, with embolization evolving as the primary therapy. Thus, radiology plays a crucial role in the detection, workup, and management of AVMs. Ultrasonography (US) is a useful initial imaging modality, particularly when AVMs involve the extremities or a superficial or accessible location. Limitations include poor identification of soft-tissue and bone components, as well as suboptimal evaluation of deep or complex AVMs. Magnetic resonance (MR) angiography is the preferred imaging modality for AVMs and should be considered in any symptomatic patient or in the initial evaluation of vascular anomalies that are equivocal at US. Computed tomographic angiography should be reserved for those patients who are unable to undergo MR angiography or for evaluation of acute symptoms, such as bleeding or airway compromise. Conventional catheter-based angiography is useful for real-time depiction and evaluation of AVMs, particularly in the planning and execution of endovascular treatment and in the diagnosis of an AVM when findings from noninvasive imaging are equivocal for a high-flow component. As with the diagnostic workup, MR angiography is the preferred posttreatment modality. (©)RSNA, 2016.
Highlights
Vascular anomalies represent multiple pathologically distinct entities with vastly different clinical manifestations, natural histories, and treatments
Tumors are classified according to their clinical behavior, and malformations are classified according to their flow characteristics, histopathologic features, and associations with other anomalies [4] (Fig 1)
Physical Examination The findings at physical examination in the setting of a visceral arteriovenous malformations (AVMs) are likely to be noncontributory, unless the AVM is large enough to be detected with a palpable bruit or thrill
Summary
Vascular anomalies represent multiple pathologically distinct entities with vastly different clinical manifestations, natural histories, and treatments. Vascular anomalies were inconsistently described, primarily on the basis of clinical appearance. As an understanding of distinct pathologic conditions emerged, further classifications evolved. Mulliken and Glowacki [1,2] proposed the first widely accepted classification of vascular anomalies in 1982, separating the anomalies into malformations or tumors on the basis of their histopathologic features. The International Society for the Study of Vascular Anomalies expanded the classification, first in 1996 [3] and most recently in 2014 [4], further categorizing vascular tumors and malformations into subdivisions of these two groups. Tumors are classified according to their clinical behavior, and malformations are classified according to their flow characteristics, histopathologic features, and associations with other anomalies [4] (Fig 1)
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