Multidetector CT angiography of pediatric vascular malformations and hemangiomas: utility of 3-D reformatting in differential diagnosis

Background: Vascular malformations can be difficult to diagnose and classify. Accurate classification is important because treatments and prognosis vary based on the type of lesion. Diagnosis is based on a combination of clinical features with a variety of imaging techniques, including US, MRI/MRA, CT, and conventional angiography. Objective: We hypothesized that imaging features seen on 3-D reformatted images obtained with multidetector CT angiography (CTA) would aid in differential diagnosis of types of vascular anomalies. Materials and methods: We retrospectively reviewed CT scans of 11 patients with vascular lesions and pathologically proven diagnoses in which 3-D reformatting was obtained.Results: The 3-D images accurately diagnosed hemangiomas and lymphangiomas in all cases, in contrast to diagnosis by clinical criteria and planar CT, which was difficult or inaccurate. The 3-D CTA did not aid in the distinction between venous malformations and arteriovenous malformations (AVM), which appeared similar. Conclusions: Our preliminary observations suggest that volume-rendered reformatting is helpful in categorizing clinically significant vascular head and neck lesions, resulting in more diagnostic value than planar CT imaging alone. In particular, 3-D CTA might allow accurate differentiation of hemangiomas from AVM, and of lymphangiomas from other types of lesions, which was, in our series, not possible using clinical examination or conventional planar CT angiography.