Therapeutic implications of MR imaging of symptomatic vascular malformations

This paper reports on the role of MR imaging in the therapeutic planning for symptomatic vascular malformations (SVMs). Forty-three MR examinations were performed in 30 SVMs 19 venous malformation, 9 arteriovenous malformations (AVMs) and 2 arteriovenous fistulas (AVFs) and correlated with findings of angiography/venography. Eleven of the malformations were studied before and after embolotherapy with absolute ethanol. MR imaging consistently distinguished high-flow lesions (AVMs, AVFs) from those with low flow (venous malformations). From the standpoint of therapy, whether interventional or surgical, MR imaging complemented angiography by depicting anatomic relationships of the lesion to organs, nerves, tendons, and muscles. This has proved valuable in predicting postprocedure complications and has also influenced the interventionalist's decisions on routes of access (intravascular vs percutaneous) for safest embolization. Additionally, MR imaging is frequently more sensitive than angiography in delineating the complete extent of these malformations, including the tendency of venous malformations to be multifocal