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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Crivelli L, Millischer AE, Sonigo P, et al. Contribution of magnetic resonance imaging to the prenatal diagnosis of common congenital vascular anomalies. Pediatr Radiol 2021. Review/Other-Dx 24 patients To describe the imaging findings on prenatal ultrasound (US) and magnetic resonance imaging (MRI) of the most frequent congenital vascular anomalies (lymphatic malformations and congenital hemangiomas) to assess the accuracy of prenatal US and MRI exams for diagnosis and to evaluate the relevance of the additional information obtained by complementary fetal MRI. Twenty-four cases were included in the study, 20 lymphatic malformations and 4 hemangiomas. MRI slightly improved the diagnosis of lymphatic malformation, 85% vs. 80% at US, especially for abdominal lesions. Both methods had a low identification rate (25%) for tumors. MRI performed late in five fetuses with lymphatic malformation allowed optimized management at birth. 4
2. Francavilla ML, White CL, Oliveri B, Lee EY, Restrepo R. Intraabdominal Lymphatic Malformations: Pearls and Pitfalls of Diagnosis and Differential Diagnoses in Pediatric Patients. [Review]. AJR Am J Roentgenol. 208(3):637-649, 2017 Mar. Review/Other-Dx N/A To review the practical imaging workup and characteristic imaging appearances of intraabdominal lymphatic malformations (LMs) in the pediatric population with a brief discussion of some common differential diagnoses found in a vascular anomaly clinic. No results in abstract. 4
3. Oliver ER, Coleman BG, DeBari SE, et al. Fetal Lymphatic Malformations: More Variable Than We Think?. J Ultrasound Med. 36(5):1051-1058, 2017 May. Review/Other-Dx 73 patients To discuss fetal lymphatic malformations. We report 73 cases of prenatally detected lymphatic malformations and describe greater variability in their prenatal sonographic appearance than previously reported, including purely cystic lesions and mixed cystic and solid lesions with calcifications. 4
4. International Society for The Study of Vascular Anomalies: ISSVA classification for vascular anomalies©.  Available at: https://www.issva.org/UserFiles/file/ISSVA-Classification-2018.pdf. Review/Other-Dx N/A N/A N/A 4
5. Sadick M, Muller-Wille R, Wildgruber M, Wohlgemuth WA. Vascular Anomalies (Part I): Classification and Diagnostics of Vascular Anomalies. [Review]. ROFO Fortschr Geb Rontgenstr Nuklearmed. 190(9):825-835, 2018 Sep. Review/Other-Dx N/A To provide an overview of the current classification system and diagnostic characterization of vascular anomalies in order to facilitate interdisciplinary management of vascular anomalies. Congenital vascular anomalies are comprised of vascular tumors, based on endothelial cell proliferation and vascular malformations with underlying mesenchymal and angiogenetic disorder. Vascular tumors tend to regress with patient's age, vascular malformations increase in size and are subdivided into capillary, venous, lymphatic, arterio-venous and combined malformations, depending on their dominant vasculature. According to their appearance, venous malformations are the most common representative of vascular anomalies (70 %), followed by lymphatic malformations (12 %), arterio-venous malformations (8 %), combined malformation syndromes (6 %) and capillary malformations (4 %). 4
6. Monroe EJ. Brief Description of ISSVA Classification for Radiologists. Tech Vasc Interv Radiol 2019;22:100628. Review/Other-Dx N/A This article introduces the 2018 International Society for the Study of Vascular Anomalies (ISSVA) classification, emphasizing the biologic basis of vascular anomalies, summarizing the key features of commonly encountered entities, and serving as a foundation for subsequent articles presented herein. No results stated in the abstract. 4
7. Asilian A, Kamali AS, Riahi NT, Adibi N, Mokhtari F. Proteus Syndrome with Arteriovenous Malformation. Adv Biomed Res 2017;6:27. Review/Other-Dx 1 male child To report a case of a 10-year-old boy with confirmed Proteus syndrome characterized by high flow vascular malformation (arteriovenous [AV] malformation) unlike the usual vascular malformations seen in this syndrome. No results in abstract. 4
8. Tan WH, Baris HN, Burrows PE, et al. The spectrum of vascular anomalies in patients with PTEN mutations: implications for diagnosis and management. J Med Genet 2007;44:594-602. Observational-Dx 26 patients with PTEN mutations To characterise the cerebral and peripheral vascular anomalies in PTEN hamartoma–tumour syndrome (PHTS) that may merit close follow-up or possible intervention.To determine the clinical and radiological features that should prompt clinicians to test for a PTEN (phosphatase and tensin homologue) mutation. All 23 patients who had their head circumference measured were macrocephalic, and all 13 male patients who were fully examined had penile freckling. Vascular anomalies were found in 14/26 (54%) of patients: 8/14 (57%) had multiple lesions and 11/13 (85%) who had cross-sectional imaging had intramuscular vascular lesions. Radiographic studies showed that 12/14 (86%) were fast-flow vascular anomalies, and angiography typically showed focal segmental dilatation of draining veins. Excessive ectopic fat in the vascular anomalies was present in 11/12 (92%) of patients on CT or MRI. Intracranial developmental venous anomalies (DVAs) were found in 8/9 (89%) of patients who had brain MRI with contrast. 4
9. Turnbull MM, Humeniuk V, Stein B, Suthers GK. Arteriovenous malformations in Cowden syndrome. J Med Genet 2005;42:e50. Review/Other-Dx 2 patients To present two sisters with pathognomonic clinical features of Cowden syndrome, a frameshift PTEN mutation, and large visceral AVMs. No results in abstract. 4
10. Uller W, Fishman SJ, Alomari AI. Overgrowth syndromes with complex vascular anomalies. Semin Pediatr Surg 2014;23:208-15. Review/Other-Dx N/A To focus on the spectrum of the clinical presentation and the management strategies of the most common overgrowth syndromes with complex vascular anomalies. No results in abstract. 4
11. Obara P, McCool J, Kalva SP, et al. ACR Appropriateness Criteria® Clinically Suspected Vascular Malformation of the Extremities. J Am Coll Radiol 2019;16:S340-S47. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for clinically suspected vascular malformation of the extremities. No results stated in abstract. 4
12. American College of Radiology. ACR Appropriateness Criteria®: Clinically Suspected Pulmonary Arteriovenous Malformation (PAVM). Available at: https://acsearch.acr.org/docs/3094113/Narrative/. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. No abstract available. 4
13. Leaute-Labreze C, Harper JI, Hoeger PH. Infantile haemangioma. Lancet 2017;390:85-94. Review/Other-Dx N/A To provide a review on infantile haemangiomas. No results stated in the abstract. 4
14. Ding A, Gong X, Li J, Xiong P. Role of ultrasound in diagnosis and differential diagnosis of deep infantile hemangioma and venous malformation. J Vasc Surg Venous Lymphat Disord. 7(5):715-723, 2019 09. Observational-Dx 135 patients To characterize and differentiate ultrasound (US) findings of deep infantile hemangioma (DIH) and venous malformation (VM). On gray-scale US images, DIH and VM were more common in subcutaneous soft tissue, but VM could invade the muscle. Most DIHs were expressed as hyperechoic structures (47.0%), had a well-defined border (74.2%), and were homogeneous (53%), whereas the majority of VMs showed mixed echoic with anechoic structures (87.8%), had an ill-defined border (58.1%), and were heterogeneous (100%). On color Doppler US, most DIHs (90.9%) showed high vascular density, whereas only a few blood flow signals were found in most VMs (98.6%). On elastic US, VM was softer than DIH (2.9 ± 0.8 vs 2.6 ± 0.5; P = .048). After DIH involution, the distance from the body surface increased (P = .015); the lesion's vertical diameter, peak arterial systolic velocity, and Vmax were significantly decreased (P = .006, P = .047, and P = .026, respectively). Also, early VM (<18 months) has the typical US performance of VM. Compared with elastic US, gray-scale and Doppler US provided stronger evidence for differential diagnosis. 3
15. Restrepo R, Palani R, Cervantes LF, Duarte AM, Amjad I, Altman NR. Hemangiomas revisited: the useful, the unusual and the new. Part 1: overview and clinical and imaging characteristics. [Review]. Pediatr Radiol. 41(7):895-904, 2011 Jul. Review/Other-Dx N/A To review and illustrate the classification, pathogenesis, clinical appearance, natural history and imaging characteristics of hemangiomas. No results in abstract. 4
16. Leaute-Labreze C, Baselga Torres E, Weibel L, et al. The Infantile Hemangioma Referral Score: A Validated Tool for Physicians. Pediatrics 2020;145. Observational-Dx 42 patients To use a validated a reliable instrument (the Infantile Hemangioma Referral Score) for timely and adequate referral of patients with infantile hemangioma to experts by nonexpert primary physicians. A total of 60 primary physicians from 7 different countries evaluated the 42 gold standard cases (without reference to the IHReS tool); 45 primary physicians evaluated these cases using the IHReS questionnaire, and 44 completed retesting using the instrument. IHReS had a sensitivity of 96.9% (95% confidence interval 96.1%–97.8%) and a specificity of 55.0% (95% confidence interval 51.0%–59.0%). The positive predictive value and negative predictive value were 40.5% and 98.3%, respectively. Validation by experts and primary physicians revealed substantial agreement for interrater reliability and intrarater repeatability. 3
17. Restrepo R, Palani R, Cervantes LF, Duarte AM, Amjad I, Altman NR. Hemangiomas revisited: the useful, the unusual and the new. Part 2: endangering hemangiomas and treatment. [Review]. Pediatr Radiol. 41(7):905-15, 2011 Jul. Review/Other-Dx N/A To review  endangering hemangiomas and discuss briefly the treatment with emphasis on the recent use of propranolol. No results in abstract. 4
18. Darrow DH. Management of Infantile Hemangiomas of the Airway. Otolaryngol Clin North Am 2018;51:133-46. Review/Other-Tx N/A To discuss the management of infantile hemangiomas of the airway. No abstract available. 4
19. Bayer ML, Frommelt PC, Blei F, et al. Congenital cardiac, aortic arch, and vascular bed anomalies in PHACE syndrome (from the International PHACE Syndrome Registry). Am J Cardiol. 112(12):1948-52, 2013 Dec 15. Review/Other-Dx 150 patients To better define the incidence, characterize the clinical and radiologic features of, and provide follow-up data for cardiovascular anomalies in PHACE (Posterior fossa, Hemangiomas of the head and neck, Arterial, Cardiovascular, and Eye). This study of the International PHACE Syndrome Registry represents the largest central review of clinical, radiology, and pathology data for cardiovascular anomalies in PHACE patients to date. 62/150 (41%) subjects had intracardiac, aortic arch, or brachiocephalic vessel anomalies. Aberrant origin of a subclavian artery was the most common cardiovascular anomaly (present in 31/150 (21%) of subjects). Coarctation was the second most common anomaly, identified in 28/150 (19%), and can be missed clinically in PHACE patients because of the frequent association of arch obstruction with aberrant subclavian origin. 23/62 (37%) subjects with cardiovascular anomalies required procedural intervention. A higher percentage of hemangiomas were located on the left side of the head/neck in patients with coarctation (46% vs. 39%); however, hemangioma distribution did not predict the presence of cardiovascular anomalies overall. 4
20. Koplewitz BZ, Springer C, Slasky BS, et al. CT of hemangiomas of the upper airways in children. AJR Am J Roentgenol 2005;184:663-70. Observational-Dx 11 patients (4 males, 7 females) To report on the clinical usefulness of dynamic contrast-enhanced computed tomography (CT) in the evaluation of suspected hemangiomas of the airways in infants. No results stated in the abstract. 4
21. Paltiel HJ, Burrows PE, Kozakewich HP, Zurakowski D, Mulliken JB. Soft-tissue vascular anomalies: utility of US for diagnosis. Radiology. 214(3):747-54, 2000 Mar. Review/Other-Dx 87 vascular anomalies To determine the ultrasonographic (US) features that distinguish soft-tissue hemangioma from vascular malformation and one type of malformation from another. There were 49 hemangiomas and 38 vascular malformations. A significantly greater proportion of hemangiomas (48 of 49) compared with vascular malformations (zero of 38) consisted of a solid-tissue mass (P < .001). Vessel density was comparable for hemangioma and arteriovenous malformation (AVM) but significantly greater compared with the other vascular malformations (P < .001 in each case). No differences in mean arterial peak velocity were detected between hemangiomas and malformations. Mean venous peak velocity was significantly higher for AVM than for other vascular malformations and hemangioma. Mean resistive index was greater for lymphatic malformation than for hemangioma or AVM. Abnormal veins, arteries and veins, or cysts were univariate predictors for distinguishing between venous, arteriovenous, and lymphatic malformations (P < .001 in all cases). Solid-tissue mass was the only multivariate predictor for differentiating hemangioma from vascular malformation (likelihood ratio test = 109.8, P < .001). 4
22. Dickie B, Dasgupta R, Nair R, et al. Spectrum of hepatic hemangiomas: management and outcome. J Pediatr Surg 2009;44:125-33. Observational-Dx 26 patients To review our experience in the management of hepatic hemangiomas. Twenty-six patients were diagnosed with hepatic hemangiomas as follows: 8 focal, 12 multiple, and 6 diffuse lesions. Nineteen (73%) patients had associated cutaneous hemangiomas. Sixteen patients had multiple and 3 patients had single cutaneous hemangiomas. All patients with multiple or diffuse liver lesions were screened for heart failure and hypothyroidism. Congestive heart failure developed in 4 patients, 3/4 of these patients had diffuse lesions. Two patients required thyroid replacement because of elevated thyroid-stimulating hormone. Because of progression of disease, 9 patients required steroid treatment. Two patients were treated with vincristine and 3 patients received alpha-interferon because of poor response to steroid treatment. Two patients went on to surgical resection for failed response to medical management and worsening heart failure (left lobectomy, liver transplant). Both patients had uncomplicated postoperative courses. Five patients had a previously undescribed constellation of rapidly involuting cutaneous hemangiomas (gone by 3 months, glut-1-negative) with associated liver lesions also resolving at a faster pace (mean resolution of cutaneous hemangiomas, 1.9 vs 7.9 months; P = .001; liver, 5.8 vs 25.3 months; P = .004). All patients in our series survived. 3
23. Ji Y, Chen S, Yang K, et al. Screening for infantile hepatic hemangioma in patients with cutaneous infantile hemangioma: A multicenter prospective study. J Am Acad Dermatol 2021;84:1378-84. Observational-Dx 1656 patients (431 male, 1225 female) The aim of this study was to establish the optimal cutoff point for the number of cutaneous infantile hemangiomas (IHs) needed to screen for infantile infantile hemangiomas (IHH). In total, 676 patients with at least 3 cutaneous IHs and 980 patients with 1 or 2 focal cutaneous IHs were enrolled. Thirty-one patients were found to have IHH. A higher number of cutaneous IHs was associated with an increased risk of IHH (R = 0.973; P < .001). Receiver operating characteristic curve analysis showed that 5 cutaneous IHs was the optimal cutoff point to screen for IHH, with an area under the curve of 0.872 (P < .001; 95% confidence interval, 0.789-0.955). 2
24. Kulungowski AM, Alomari AI, Chawla A, Christison-Lagay ER, Fishman SJ. Lessons from a liver hemangioma registry: subtype classification. J Pediatr Surg 2012;47:165-70. Review/Other-Dx 121 patients To discuss the lessons from a liver hemangioma registry based on subtype classification. Of 121 patients with hepatic hemangioma, 119 were focal (n = 33), multifocal (n = 68), and diffuse (n = 18). Two patients shared features of multifocal and diffuse. The focal group had a balanced sex distribution, whereas multifocal and diffuse were more common in women (66.2% and 70.0%, respectively). Hepatic hemangioma was detected prenatally in 30% (9/30) of patients with focal disease. Detection was not possible in multifocal or diffuse hepatic hemangioma, indicating postnatal proliferation typical of common cutaneous infantile hemangioma. Cutaneous hemangiomas accompanied 77.4% (48/62) of multifocal hepatic hemangioma, 53.3% (8/15) of diffuse hepatic hemangioma, and 15.3% (4/26) of focal hepatic hemangioma. Hypothyroidism was documented in all (16/16) patients with diffuse hepatic hemangioma, 21.4% (9/42) with multifocal hepatic hemangioma, but in no patients with focal hepatic hemangioma (0/17). 4
25. Iacobas I, Phung TL, Adams DM, et al. Guidance Document for Hepatic Hemangioma (Infantile and Congenital) Evaluation and Monitoring. J Pediatr. 203:294-300.e2, 2018 12. Review/Other-Dx N/A To define the types of hepatic hemangiomas using the updated International Society for the Study of Vascular Anomalies classification and to create a set of guidelines for their diagnostic evaluation and monitoring. In the first section, we define the subtypes of hepatic hemangiomas based on the clinical course, histology, and radiologic characteristics. We recommend against using the term "hemangioma" for any vascular malformations affecting the liver or any hypervascular tumors that are not characterized by the approved definitions. We recommend against using the term "hemangioendothelioma" for infantile or congenital hemangioma. The following 2 sections dedicated to infantile hepatic hemangioma and to congenital hepatic hemangioma individually describe these subtypes in further detail, including complications to be considered during monitoring and respectively recommended screening evaluations. 4
26. Xu M, Pan FS, Wang W, et al. The value of clinical and ultrasound features for the diagnosis of infantile hepatic hemangioma: Comparison with contrast-enhanced CT/MRI. Clin Imaging. 51:311-317, 2018 Sep - Oct. Observational-Dx 45 patients To investigate the combined use of ultrasound together with clinical features to differentiate infantile hepatic hemangioma (IHH) from other focal liver lesions (FLLs) in children and to compare the efficacy of the combined method to that of contrast-enhanced computed tomography/magnetic resonance imaging (CECT/MRI). Compared with the control FLL group, the IHH group had a younger age at diagnosis (P = 0.008), lower alpha-fetoprotein (AFP) levels (P = 0.000), smaller lesion sizes (P = 0.000), and a higher tumor proportion with a resistance index (RI) of <0.7. Multiple logistic regression analysis showed that age, size, RI and AFP were independent factors for predicting IHH. Receiver operating characteristic (ROC) curve analysis showed that the AUC (area under the curve) of the four combined independent factors was 0.881 (95% CI: 0.744-0.960), while the AUC for the CECT/MRI method was 0.905 (95% CI: 0.774-0.973), and the combined AUC for the independent factors and CECT/MRI was 0.929 (95% CI: 0.805-0.985). There were not statistically significant among the three AUCs (P > 0.05). 2
27. El-Ali AM, McCormick A, Thakrar D, Yilmaz S, Malek MM, Squires JH. Contrast-Enhanced Ultrasound of Congenital and Infantile Hemangiomas: Preliminary Results From a Case Series. AJR Am J Roentgenol. 214(3):658-664, 2020 03. Review/Other-Dx 10 patients To describe the contrast-enhanced ultrasound (CEUS) features of infantile hemangioma (IH) and congenital hemangioma (CH). Of the 10 patients, five had CHs and five had IHs. All 10 lesions were hyperenhancing in the early arterial phase. In the portal venous phase, four of five (80%) CHs showed hyperenhancement relative to normal liver parenchyma, whereas four of five (80%) IHs showed isoenhancement. In the late phase, washout of contrast material was seen in three of five (60%) IHs, whereas one IH remained isoenhancing and one IH was hyperenhancing. None of the CHs showed late washout. Interobserver kappa coefficients for CEUS features ranged from 0.60 to 1.00. 4
28. Anupindi SA, Biko DM, Ntoulia A, et al. Contrast-enhanced US Assessment of Focal Liver Lesions in Children. Radiographics 2017;37:1632-47. Review/Other-Dx N/A To review the composition, physiologic properties, and safety profile of ultrasound (US) contrast agents; describe their technique for performing contrast-enhanced US; and highlight the advantages of using this modality to assess common focal liver lesions in children. No results stated in the abstract. 4
29. van Rijswijk CS, van der Linden E, van der Woude HJ, van Baalen JM, Bloem JL. Value of dynamic contrast-enhanced MR imaging in diagnosing and classifying peripheral vascular malformations. AJR Am J Roentgenol. 178(5):1181-7, 2002 May. Observational-Dx 27 patients. To evaluate prospectively whether MR imaging, including dynamic contrast-enhanced MR imaging, could be used to categorize peripheral vascular malformations and especially to identify venous malformations that do not need angiography for treatment. Excellent agreement between the two observers in determining MR categories (gamma = 0.99) existed. Agreement between MR categories and angiographic categories was high for both observers (gamma = 0.97 and 0.92). Sensitivity of conventional MR imaging in differentiating venous and nonvenous malformations was 100%, whereas specificity was 24-33%. Specificity increased to 95% by adding dynamic contrast-enhanced MR imaging, but sensitivity decreased to 83%. 1
30. Hammer S, Uller W, Manger F, Fellner C, Zeman F, Wohlgemuth WA. Time-resolved magnetic resonance angiography (MRA) at 3.0 Tesla for evaluation of hemodynamic characteristics of vascular malformations: description of distinct subgroups. Eur Radiol. 27(1):296-305, 2017 Jan. Observational-Dx 83 patients (57 female, 26 male) To discuss the quantitative evaluation of hemodynamic characteristics of arteriovenous and venous malformations using time-resolved magnetic resonance angiography (MRA) at 3.0 Tesla. All AVMs showed a high-flow hemodynamic pattern. Two significantly different (p < 0.001) types of venous malformations emerged: VMs with arteriovenous fistulas (AVF) (median signalmax 737 %, IQR [interquartile range] = 511 - 1182 %; median tonset 5 s, IQR = 5 - 10 s; median tmax 35 s, IQR = 26 - 40 s) and without AVFs (median signalmax 284 %, IQR = 177-432 %; median tonset 23 s, IQR = 15 - 30 s; median tmax 60 s, IQR = 55 - 75 s). 2
31. Flors L, Leiva-Salinas C, Maged IM, et al. MR imaging of soft-tissue vascular malformations: diagnosis, classification, and therapy follow-up. Radiographics 2011;31:1321-40; discussion 40-1. Review/Other-Dx N/A To review the classification of vascular anomalies and their principal clinical features, with a focus on vascular malformations and tumors of developmental origin that occur in soft tissue.To describe an optimized MR imaging technique for evaluation of these lesions and the different MR imaging features that aid in diagnosis, proper classification, and treatment planning.To describe the appearances of these lesions after treatment. No results in abstract. 4
32. Tan EJ, Zhang S, Tirukonda P, Chong LR. REACT - A novel flow-independent non-gated non-contrast MR angiography technique using magnetization-prepared 3D non-balanced dual-echo dixon method: Preliminary clinical experience. Eur J Radiol Open 2020;7:100238. Review/Other-Dx N/A To describe our initial clinical experience and potential applications of Relaxation-Enhanced Angiography without Contrast and Triggering (REACT) in the evaluation of various vascular disorders with reference to established conventional contrast-enhanced angiography techniques. No results stated in the abstract. 4
33. Fleecs JB, Artz NS, Mitchell GS, Chan SS. Non-contrast magnetic resonance angiography/venography techniques: what are my options?. [Review]. Pediatric Radiology. 52(2):271-284, 2022 Feb. Review/Other-Dx N/A To summarize the non-contrast magnetic resonance (MR) angiography methods and their relative advantages and disadvantages. No results in the abstract. 4
34. Vilanova JC, Barcelo J, Villalon M. MR and MR angiography characterization of soft tissue vascular malformations. Curr Probl Diagn Radiol 2004;33:161-70. Review/Other-Dx N/A To review the magnetic resonance (MR) and MR angiography (MRA) imaging characteristics of soft-tissue hemangiomas to provide a helpful guide for radiologists to perform a more specific diagnosis and better management of these anomalies. No results stated in the abstract. 4
35. Hammer S, Zeman F, Fellner C, Wohlgemuth WA, Uller W. Venous Malformations: Phleboliths Correlate With the Presence of Arteriovenous Microshunts. AJR Am J Roentgenol. 211(6):1390-1396, 2018 12. Observational-Dx 83 patients The objective of this study was to identify differences between venous malformations (VMs) with arteriovenous (AV) microshunts and VMs without AV microshunts. Of the 83 patients, 56 (67%) presented with AV microshunts. The tonset (p = 0.001), absolute and relative lesion volume (p = 0.001), and number of phleboliths (p = 0.038) differed significantly between these two subgroups. With use of a multivariable regression model, the strongest indicator for VM with AV microshunts was the presence of more than two phleboliths (odds ratio, 2.80; p = 0.007). No differences were noted regarding patient demographic characteristics and history or lesion morphologic features or anatomy. 3
36. Kollipara R, Dinneen L, Rentas KE, et al. Current classification and terminology of pediatric vascular anomalies. [Review]. AJR Am J Roentgenol. 201(5):1124-35, 2013 Nov. Review/Other-Dx N/A To review new terminology to diagnose, classify, and refer patients with vascular anomalies for additional imaging, intervention, and treatment. No results stated in abstract. 4
37. van Es J, Kappelhof NA, Douma RA, Meijers JCM, Gerdes VEA, van der Horst CMAM. Venous thrombosis and coagulation parameters in patients with pure venous malformations. Neth J Med. 75(8):328-334, 2017 Oct. Observational-Dx 69 patients To determine the prevalence of superficial vein thrombosis and/or venous thromboembolism, and to assess whether patients with pure venous malformations (VM) have a hypercoagulable state. In total, 69 patients with pure VMs were eligible, median age was 30 years (range 12-63) and 52% were female. A total of 68 patients underwent CUS. Superficial vein thrombosis was observed in 10 (15%) cases; 1 patient had a current asymptomatic deep venous thrombosis. Residual superficial or deep thrombosis was observed in 25 patients (36%). In total, 49% had either a history or current signs of a thrombotic event and overall 10% had venous thromboembolism. In approximately 50% of the patients the D-dimer level was above 0.5 mg/l. Median P-selectin and Von Willebrand factor levels were 29 ng/ml (interquartile range (IQR) 21-34) and 108% (IQR 83-132), respectively. No differences were observed in the coagulation parameters between the patients with and without current clots in their VM. 3
38. Tan KT, Simons ME, Rajan DK, Terbrugge K. Peripheral high-flow arteriovenous vascular malformations: a single-center experience. J Vasc Interv Radiol 2004;15:1071-80. Observational-Dx 31 patients To assess the long-term outcomes of patients with high-flow arteriovenous malformations (HFAVMs) of the extremities. Follow-up was completed in 30 patients (mean duration, 3.3 years; range, 0.2-13 years), with one patient lost to follow-up. Nineteen had symptoms that warranted endovascular treatment: 13 underwent embolotherapy and six were considered unsuitable because of challenging anatomy that rendered embolization unsafe or impossible. Eleven patients' symptomatology did not warrant treatment and these patients were treated conservatively. The 13 patients treated with embolotherapy underwent a total of 27 treatment sessions (mean, 2.1 sessions per patient; range, 1-5). N-butyl cyanoacrylate and polyvinyl alcohol were used as the embolic agent in 11 and two patients, respectively. Three patients had complete resolution of HFAVM clinically and angiographically, and five patients' symptoms were controlled despite persistence of the HFAVM angiographically. Five patients had no improvement after treatment. Two major complications occurred (7.4% per session or 15.4% per patient): one patient developed a tibial plateau compression fracture and one patient had temporary L5 neuropathy after embolization of the pelvis and thigh. Of the six patients who were considered unsuitable for embolotherapy, one patient died of hepatocellular carcinoma, two had significant progression of symptoms, and the remaining three patients' symptomatology was unchanged. Only one of the nine patients with mild symptoms at presentation had symptom progression during follow-up. 2
39. Johnson JB, Cogswell PM, McKusick MA, Binkovitz LA, Riederer SJ, Young PM. Pretreatment imaging of peripheral vascular malformations. J Vasc Diagn 2014;2014:121-26. Review/Other-Dx N/A To discuss pretreatment imaging findings in four patients with peripheral VMs and how diagnostic imaging helped guide management. No results in abstract. 4
40. Li JL, Liu HJ, Cui YH, et al. Mediastinal hemangiomas: Spectrum of CT and MRI findings - retrospective case series study and systematic review of the literature. Eur J Radiol. 126:108905, 2020 May. Review/Other-Dx 17 patients To analyze the imaging manifestations of mediastinal hemangioma (MH) by computed tomography (CT) and magnetic resonance imaging (MRI) to aid in its successful diagnosis and preoperative evaluation. The anterior, middle, and posterior mediastinum were involved in 13, 13, and 8 cases, respectively. The masses size varied from 20 to 233 mm. Irregular, dumbbell-like, and oval masses were found in 13, 2, and 2 cases, respectively, while with pampiniform growth in 16 cases and expansive growth in 1 case. Mixed density, homogeneous density solid masses, and heterogeneous density masses with dominant fat were found in 9, 5, and 3 cases, respectively, showing mild or significant enhancement in aortic phase while no or mild enhancement in pulmonary artery phase. Draining veins were found in 16 cases and feeding arteries in 10 cases. Phleboliths were detected in 10 cases, splenic hemangiomas in 6 cases, and left lateral-chest-wall hemangioma in 1 case. In MRI sequences, mixed signal was found on T1WI and heterogeneous hypersignal with nodular or linear hyposignal on T2WI in 5 cases, mild or significant enhancement in 4 cases, draining veins in 2 cases, and no feeding arteries or phleboliths were seen. 4
41. Merrow AC, Gupta A, Patel MN, Adams DM. 2014 Revised Classification of Vascular Lesions from the International Society for the Study of Vascular Anomalies: Radiologic-Pathologic Update. Radiographics 2016;36:1494-516. Review/Other-Dx N/A To provide a radiologic and pathological update on the 2014 revised classification of vascular lesions from the International Society for the Study of Vascular Anomalies (ISSVA). No results stated in the abstract. 4
42. Saboo SS, Chamarthy M, Bhalla S, et al. Pulmonary arteriovenous malformations: diagnosis. Cardiovasc Diagn Ther 2018;8:325-37. Observational-Dx N/A To review various types of PAVMs, role of various imaging modalities in their evaluation, imaging appearances and complications of various types of PAVMs. To review the clinical manifestations, pathophysiology and screening protocol for PAVMs with brief mention of available treatment options. No results available 4
43. Gamondes D, Si-Mohamed S, Cottin V, et al. Vein Diameter on Unenhanced Multidetector CT Predicts Reperfusion of Pulmonary Arteriovenous Malformation after Embolotherapy. Eur Radiol. 26(8):2723-9, 2016 Aug. Observational-Dx 88 patients To evaluate the value of the diameter of the draining vein of pulmonary arteriovenous malformation (PAVM) on unenhanced chest multidetector computed tomography (MDCT) in diagnosing reperfusion after percutaneous vaso-occlusion therapy. Eighty-eight of 100 patients met inclusion criteria, in whom 62 of 176 PAVMs were reperfused at angiogram. The mean diameter of the efferent vein on MDCT was 4.3 ± 2.1 mm in patent PAVMs and 1.8 ± 0.9 mm in non-patent PAVMs (p < 0.0001). The optimal cutoff diameter based on ROC analysis was 2.5 mm (sensitivity = 98.4 %; specificity = 87.7 %). 2
44. Henzler T, Vogler N, Lange B, et al. Low dose time-resolved CT-angiography in pediatric patients with venous malformations using 3rd generation dual-source CT: Initial experience. Eur J Radiol Open 2016;3:216-22. Review/Other-Dx 7 children (2 male, 5 female) 4
45. Ghouri MA, Gupta N, Bhat AP, et al. CT and MR imaging of the upper extremity vasculature: pearls, pitfalls, and challenges. Cardiovasc Diagn Ther 2019;9:S152-S73. Review/Other-Dx N/A This article reviews the upper extremity arterial vascular anatomy, discusses the computed tomography angiography (CTA) and magnetic resonance angiography (MRA) imaging, various pitfalls, and challenges and discuss imaging manifestations of upper extremity arterial pathologies. No results stated in the abstract. 4
46. Yoneyama M, Zhang S, Hu HH, et al. Free-breathing non-contrast-enhanced flow-independent MR angiography using magnetization-prepared 3D non-balanced dual-echo Dixon method: A feasibility study at 3 Tesla. Magn Reson Imaging 2019;63:137-46. Observational-Dx 12 patients To investigate the feasibility of using a new pulse sequence called Relaxation-Enhanced Angiography without Contrast and Triggering (REACT) for free-breathing non-contrast-enhanced MR angiography (NCE-MRA) for multiple anatomies on 3T. Two magnetization-preparation pulses were incorporated witha three-dimensional dual-echo Dixon sequence. A T2-prep pulse, followed by a non-selective inversion pulse witha short inversion time, together suppressed tissue with short T1 and T2, while enhancing the signal of nativeblood with long T1 and T2. A two-point non-balanced gradient-echo Dixon method, based on dual-echo acquisitionwith semi-flexible echo times for water-fat separation, was used for improved fat suppression over alarge field of view. General image quality, vasculature visibility, and clinical indications of the proposed methodwere investigated in healthy subjects and patients in both torso and extremities based on visual inspection.Preliminary results from REACT obtained in free-breathing with no cardiac triggering showed uniform suppressionof background tissue over the field of view and robust blood-to-tissue contrast over multiple anatomies. 3
47. Lidsky ME, Spritzer CE, Shortell CK. The role of dynamic contrast-enhanced magnetic resonance imaging in the diagnosis and management of patients with vascular malformations. J Vasc Surg. 56(3):757-64.e1, 2012 Sep. Observational-Dx 122 patients This study assessed the utility of dynamic contrast-enhanced magnetic resonance imaging (dceMRI) in distinguishing high-flow from low-flow lesions, a technique that has previously not been widely applied or evaluated in this patient population. The study included 122 patients (aged <1 to 70 years) comprising 52 males (42.6%) and 70 females (57.4%). Pain (72 patients; 59%) and swelling (88 patients; 72.1%) were the most common presenting symptoms. All patients underwent dceMRI. Of these, 68 had confirmatory imaging (n = 15) or intervention (n = 53). The dceMRI was able to definitively and correctly distinguish high-flow from low-flow lesions in 57 studies, for an accuracy rate of 83.8%. In the remaining 11 studies, dceMRI correctly queried flow status but not definitively, and confirmatory angiography was required. 3
48. Rauch M, Schild HH, Strunk H. Contrast enhanced ultrasound of a hepatic soft tissue angiosarcoma metastasis. Case report. Med Ultrason 2014;16:271-3. Review/Other-Dx N/A To discuss a case report on the contrast enhanced ultrasound (CEUS) regarding a hepatic soft tissue angiosarcoma metastasis. No abstract available. 4
49. Park KB, Do YS, Kim DI, et al. Predictive factors for response of peripheral arteriovenous malformations to embolization therapy: analysis of clinical data and imaging findings. J Vasc Interv Radiol. 23(11):1478-86, 2012 Nov. Observational-Tx 176 patients (73 males, 103 females) To find a significant predictive factor for the efficacy of endovascular treatment of peripheral arteriovenous malformations (AVMs). Overall, 68 patients (39%) were cured, 91 patients (52%) showed a partial response, nine patients (5%) showed no response, treatment failed in seven patients (4%), and treatment aggravated the condition in one patient (1%). The overall complication rate was 45% (79 of 176 patients). Minor complications developed in 62 patients (35%) and major complications developed in 17 (10%). Statistically, the extent of AVMs (odds ratio, 0.199) and angiographic classification (odds ratio, 0.162) were significant predictive factors for overall clinical outcome. 1
50. Wiesinger I, Schreml S, Wohlgemuth WA, Stroszczynski C, Jung EM. Perfusion quantification of vascular malformations using contrast-enhanced ultrasound (CEUS) with time intensity curve analysis before and after treatment: First results. Clin Hemorheol Microcirc. 62(4):283-90, 2015 Sep 25. Observational-Dx 29 patients To quantify perfusion changes of vascular malformations before and after the first interventional treatment using contrast-enhanced ultrasound (CEUS). For VM there was a significant perfusion difference (p < 0.05) in AUC between centre and the surrounding tissue before (323.1 vs. 130.4 rU) and after treatment (331.0 vs. 106.9 rU). There was no significant difference for TTP in ROIs of VM (19.1 vs. 26.5 sec). After the treatment there was a significant decrease in AUC for all three regions in AVMs, and an increase in TTP for AVM. However TTP for AVM in the centre ROI still remained shorter than in the surrounding tissue even after therapy (20.9 vs. 25.4 sec). 3
51. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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