MR‐guided percutaneous sclerotherapy of low‐flow vascular malformations: Clinical experience using a 1.5 tesla MR system

• Published in: Journal of magnetic resonance imaging Vol. 45; no. 4; pp. 1154 - 1162
• Main Authors: O'Mara, Daniel M., DiCamillo, Paul A., Gilson, Wesley D., Herzka, Daniel A., Wacker, Frank K., Lewin, Jonathan S., Weiss, Clifford R.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.04.2017
• Subjects: Abdomen; Adolescent; Adult; Child; Complications; Extremities; Feasibility Studies; Female; Fluoroscopy; Humans; Intervention; Low flow; lymphatic malformations; Magnetic resonance imaging; Magnetic Resonance Imaging, Interventional - methods; Male; Middle Aged; Neck; Pain; Patients; Pelvis; Qualitative analysis; Quantitative analysis; Real time; Sclerotherapy; Sclerotherapy - methods; Skin diseases; Therapy; Treatment Outcome; Vascular Malformations - diagnostic imaging; Vascular Malformations - therapy; venous malformations; Young Adult; sclerotherapy; lymphatic malformations; venous malformations
• ISSN: 1053-1807; 1522-2586
• DOI: 10.1002/jmri.25502

Purpose To demonstrate the feasibility, safety, and effectiveness of image‐guided sclerotherapy of low‐flow vascular malformations using a 1.5 Tesla (T) MR scanner with real‐time imaging capability and in‐suite fluoroscopy. Materials and Methods Thirty‐three procedures were performed with real‐time 1.5T MR‐guidance on 22 patients with a vascular malformation in the neck (n = 2), chest (n = 6), abdomen and pelvis (n = 15), and extremities (n = 11). Quantitative analysis was performed for changes in (a) planning time, (b) targeting time (interval between needle skin puncture and lesion access), (c) intervention time (interval between needle skin puncture and needle removal), and (d) total procedure time. Qualitative analysis was performed for (a) success of therapy and (b) occurrence of complications. Results Technical success was achieved in 29 of 33 procedures. The average planning time did not significantly change between the first seven procedures and the last seven procedures (P = 0.447). The average targeting time decreased by 0:24:45 (hours:minutes:seconds) (P = 0.043), the average intervention time decreased by 0:26:58 (P = 0.022), and the average procedure time decreased by 0:28:41 (P = 0.046) when comparing the first seven procedures and the last seven procedures. Overall, there was an improvement in the patients' predominant symptoms following 82% of procedures, including a significant decrease in average pain following therapy (P < 0.001). There was a minor complication rate of 3% with no major complications. Conclusion MR‐guided percutaneous sclerotherapy seems to be a safe, effective, and versatile technique for treating low‐flow vascular malformations. Level of Evidence: 3 J. Magn. Reson. Imaging 2017;45:1154–1162