Treatment of musculoskeletal vascular anomalies.

The treatment of musculoskeletal vascular anomalies can be accomplished by means of challenging image-guided interventional techniques. Most patients benefit clinically from these procedures. Careful planning, appropriate training, and adequate patient care during and after the procedure are important to achieve optimal results and to minimize procedure-related risks.

Vascular anomalies (birthmarks) of the foot and ankle.

Vascular anomalies (birthmarks) commonly involve the feet and ankles. Little is known about these anomalies among practicing physicians. In this article, vascular anomalies are described, and detailed information is presented regarding appropriate diagnostic work-up and treatment strategies.

An appropriate diagnostic workup for suspected vascular birthmarks.

Birthmarks are common and commonly ignored by patients and primary care doctors. Yet they sometimes represent significant vascular anomalies that require diagnosis and treatment. We summarize when and how to work up a variety of vascular anomalies.

Venous variations of the brain and cranial vault.

Vascular anomalies involving both intra- and extra-cranial structures are more common than previously thought. It is important to evaluate the brain and its coverings carefully when imaging cervicofacial vascular malformations. Scientific knowledge regarding developmental mechanisms responsible for blood vessel formation is increasing rapidly and, hopefully, will contribute to better understanding of these clinical and imaging "patterns."

Angiographic features of rapidly involuting congenital hemangioma (RICH).

Rapidly involuting congenital hemangioma (RICH) is a recently recognized entity in which the vascular tumor is fully developed at birth and undergoes rapid involution. Angiographic findings in two infants with congenital hemangioma are reported and compared with a more common postnatal infantile hemangioma and a congenital infantile fibrosarcoma. Congenital hemangiomas differed from infantile hemangiomas angiographically by inhomogeneous parenchymal staining, large and irregular feeding arteries in disorganized patterns, arterial aneurysms, direct arteriovenous shunts, and intravascular thrombi. Both infants had clinical evidence of a high-output cardiac failure and intralesional bleeding. This congenital high-flow vascular tumor is difficult to distinguish angiographically from arteriovenous malformation and congenital infantile fibrosarcoma.

Magnetic resonance of vascular anomalies.

More than half of the patients with vascular anomalies referred to the Vascular Anomalies Clinic at Children's Hospital, Boston, have been misdiagnosed. A major consequence of misdiagnosis is inappropriate treatment, including deferral of necessary treatment and inappropriate use of pharmacotherapy, radiation, surgery, and embolotherapy. Hemangiomas and vascular malformations are distinct categories with completely different biologic and clinical behavior, therapeutic requirements, and imaging features. This article reviews the biologic classification of vascular anomalies and corresponding MR imaging features, and presents a simplified guide to diagnosis.

Outcomes of primary image-guided drainage of parapneumonic effusions in children.

OBJECTIVE: To assess the outcome of image-guided needle aspiration when compared with image-guided percutaneous catheter drainage in the management of parapneumonic effusions in children. METHODS: A retrospective chart review was conducted of the medical records, microbiology, and radiology reports of 67 children who presented with parapneumonic effusions and underwent primary image-guided drainage between April 1, 1995, and April 1, 2000. RESULTS: Thirty-four patients had aspiration only, and 33 patients had pigtail catheters placed. The 2 drainage methods had similar median length of stay and complication rates. The reintervention rate in this study was 27% (18 patients). Children who underwent primary aspiration without catheter placement had significantly higher rates of reintervention. Method of drainage, pH lower than 7.2, and loculation of the fluid collection were independent predictors of reintervention. A low glucose level was an additive predictor of reintervention when the pH was low. CONCLUSIONS: Aspiration and catheter drainage of parapneumonic effusions had similar complication rates and lengths of stay, but children who underwent primary aspiration had significantly higher reintervention rates, particularly when pH and glucose levels were low. Therefore, primary catheter placement for parapneumonic effusions should be considered in children who undergo diagnostic thoracentesis. The decision regarding tube placement could be facilitated by the on-site availability of a pH meter and a glucometer.

Estimation of gallbladder ejection fraction utilizing cholecystokinin-stimulated magnetic resonance cholangiography and comparison with hepatobiliary scintigraphy.

PURPOSE: To evaluate the utility of magnetic resonance cholangiography (MRC) in estimation of gallbladder ejection fraction (GBEF) and to comparing this value to the conventional method, hepatobiliary scintigraphy (HBS). MATERIALS AND METHODS: Twenty-one healthy volunteers were imaged on sequential weeks to determine GBEF using MRC and HBS. GBEF was calculated by HBS after infusion of 20 ng/kg of sincalide following injection of 111 Mbq of Tc 99(m) mebrofenin. For estimation by MRC, imaging of the gallbladder was performed before and after slow infusion of sincalide every 5 minutes, for a total of 60 minutes. Gallbladder imaging was performed using a heavily T2-weighted 2D fast spin echo (FSE) sequence. Data was analyzed using a variance component analysis technique. RESULTS: Mean GBEF by HBS was 65.7%, with an SD of +/-27.3%. Mean GBEF by MRC was 62.7%, with an SD of +/- 20.4%. If minimum normal GBEF is set at 35%, two of the cases showed discordance, with HBS calculating an abnormally low average GBEF compared to MRC. Additionally, two cases showed abnormally low GBEF for both modalities. The coefficient of correlation between HBS and MRC was 0.72. Inter- and intraobserver variance is acceptable within the two modalities with <1.1% variation. CONCLUSION: GBEF can be calculated with MRC, yielding similar values when a group of volunteers are considered. Further study with symptomatic patients is needed to determine the validity of this technique for clinical diagnosis.