Use of doppler color flow imaging for differential diagnosis of vascular malformations: A preliminary report

doi:10.1016/0278-2391(95)90706-8

Journal of Oral and Maxillofacial Surgery

Volume 53, Issue 4, April 1995, Pages 369-374

https://doi.org/10.1016/0278-2391(95)90706-8 Get rights and content

Abstract

$Purpose:$ To ascertain whether Doppler color flow imaging can demonstrate the characteristics of blood flow within vascular lesions.

$Materials and Methods:$ Two cases with vascular malformation in the soft tissues of the maxillofacial region were examined. One was an arteriovenous, high-flow type malformation involving the tongue, the floor of the mouth, and the mandible. The other was a venous, low-flow type malformation of the whole tongue. The technique used was the same as that for the extraoral approach in conventional ultrasound imaging.

$Results:$ Doppler color flow imaging provided valuable information on the hemodynamic characteristics of the vascular malformations when comparing with other diagnostic forms of imaging, and clearly differentiated between high- and low-flow vascular lesions.

$Conclusion:$ Doppler color flow imaging was suggested to be another method in our armamentarium for differential diagnosis of vascular malformations.

References (24)

LB Kaban et al.
Vascular anomalies of the maxillofacial region
J Oral Maxillofac Surg
(1986)
H Baurmash et al.
A conservative approach to the management of orofacial vascular lesions in infants and children: Report of cases
J Oral Maxillofac Surg
(1991)
PE Larsen et al.
A systematic approach to management of high-flow vascular malformations of the mandible
J Oral Maxillofac Surg
(1993)
TJ Svane et al.
Arteriovenous malformation of the mandible and its treatment: A case report
Oral Surg Oral Med Oral Pathol
(1989)
K Bunel et al.
Central hemangioma of the mandible
Oral Surg Oral Med Oral Pathol
(1993)
SJ McKenna et al.
Delayed management of a mandibular vascular malformation
J Oral Maxillofac Surg
(1989)
SW Hiatt et al.
Management of a mandibular high-flow vascular malformation
J Oral Maxillofac Surg
(1989)
MW Greene et al.
Arteriovenous malformation of the mandible: Survey of previously unreported cases and case report
J Oral Maxillofac Surg
(1989)
MB Abouzgia et al.
Recurrent arteriovenous malformation of the mandible: A case report
J Oral Maxillofac Surg
(1992)
MM El-Sheikh et al.
Vascular malformations of the jaw bones: Report on nine patients
J Craniomaxillofac Surg
(1993)

E Piette et al.

The diagnostic limitations of ultrasonography in maxillofacial surgery

J Craniomaxillofac Surg

(1987)

CP Oates et al.

Doppler ultrasound: A valuable diagnostic aid in a patient with a facial hemangioma

Oral Surg

(1985)

Cited by (25)

Vascular malformations (II). Diagnosis, pathology and treatment
2007, Actas Dermo-Sifiliograficas
El diagnóstico de las malformaciones vasculares es fundamentalmente clínico, y está basado en la evolución y morfología de las lesiones, siendo necesaria en muy raras ocasiones la realización de una biopsia para valorar histológicamente la naturaleza de los vasos. Para delimitar la extensión de las malformaciones, así como el compromiso músculo-esquelético y visceral, son necesarias las pruebas de imagen. La incorporación de nuevas técnicas como la angio-tomografía computarizada (TC) o la angio-resonancia magnética (RM) en 3D agilizan el diagnóstico de algunas malformaciones vasculares, especialmente las combinadas extensas tipo síndrome de Klippel-Trenaunay, limitando la necesidad de procedimientos invasivos. Por otra parte, los avances en tecnología láser, concretamente el láser de colorante pulsado para la mancha en vino de Oporto y el láser de Nd:YAG para las malformaciones venosas superficiales, la escleroterapia con microespuma en las malformaciones venosas y combinadas de bajo flujo, y los nuevos materiales embolizantes asociados con la cirugía en malformaciones arteriovenosas, son terapias emergentes para el seguimiento de los pacientes. La segunda parte de esta revisión está enfocada al diagnóstico complementario (pruebas de imagen, histología y pruebas accesorias) y al tratamiento multidisciplinar y específico según los diferentes grupos.
Diagnosis of vascular malformations is essentially clinical, based on the evolution and morphology of lesions. A biopsy is rarely needed to evaluate the nature of the vessels. Imaging examinations are necessary to assess the extension of malformations as well as the osteomuscular and visceral compromise. New techniques such as 3D angio-CT scan and angio-MRI improve the diagnosis of some vascular malformations, especially the large combined ones such as Klippel-Trénaunay syndrome, thus limiting the need for invasive procedures. On the other hand, the advances in laser technology, particularly pulsed dye laser for port-wine stains and Nd:YAG laser for superficial venous malformations constitute new alternatives for the management of these patients. Other emergent treatments include microfoam sclerotherapy for venous and combined, slow-flow malformations, and new embolizing materials associated to surgery for arterio-venous malformations. The second part of this review is focused on the complementary diagnosis (imaging exams, pathology and accessory tests) and multidisciplinary and specific treatment based on the different groups.
Colour duplex ultrasound-guided sclerotherapy: A new approach to the management of patients with peripheral vascular malformations
2003, Clinical Imaging
Introduction: Colour duplex ultrasound (CDU)-guided sclerotherapy is a valuable modality for treating peripheral vascular malformations (PVMs). Patients and Methods: Between April 1996 and October 1998, 75 patients (age 5–65 years) with PVMs were subjected to CDU. Sclerotherapy was subsequently performed on 40 patients, without sedation, using 3% sodium tetradecyl sulfate, with mean follow-up of 4 years. Results: CDU of the 33 high-flow lesions (HFLs) revealed direct arteriovenous (AV) communicating channels with very high forward diastolic flow in seven lesions (arteriovenous fistulas, AVFs), but not in the other 25 lesions (non-AVF). One was a mixed lesion picked up by CDU. Sixteen HFLs were subjected to sclerotherapy; 13 (81.25%) regressed. CDU of the 42 low-flow lesions (LFLs) helped categorize them into Type 1, where no supplying arteries could be seen (12 lesions), and Type 2, where supplying arteries were seen (30 lesions). Type 2 lesions could be further subcategorized based on the spectral trace of their supplying arteries: Type 2a, high-resistance flow (25 lesions); and Type 2b, low-resistance flow with a small forward diastolic flow (5 lesions). Twenty-four LFLs were subjected to sclerotherapy; 20 (83.3%) regressed. Conclusion: CDU findings correlated well with the clinical appearances of PVMs, and helped to further subcategorize these lesions based on flow. Significant differences in the Doppler flowmetry parameters of the supplying arteries seen in the HFLs and LFLs have enabled us to suggest values for differentiating between them. CDU was also found to be valuable in the follow-up of these lesions.
Characterization of maxillofacial soft tissue vascular anomalies by ultrasound and color doppler imaging: An adjuvant to computed tomography and magnetic resonance imaging
2003, Journal of Oral and Maxillofacial Surgery
Citation Excerpt :
Oates et al,28 in 1985, published a short report in the OMS literature, and in 199029 published a more extensive study that showed the value of combined CT, MRI, US, and Doppler imaging in the diagnosis and management of vascular and other oral and cervical masses; in one of their cases color Doppler was used. Yoshida et al,30 in 1995, also illustrated the value of color Doppler imaging in the differential diagnosis and treatment of 2 cases of vascular malformation specifically influenced by the blood flow characteristics shown by color Doppler. The past literature on developmental vasoformative lesions is seen to be filled with a confusing hybrid terminology and theories of etiology.
Purpose: The special imaging and physical properties of ultrasound and color Doppler offer opportunity for continued investigation in oral and maxillofacial surgery. This study prospectively investigated ultrasound and color Doppler in addition to computed tomography (CT) and magnetic resonance imaging (MRI) in the characterization of several vascular or suspected vascular anomalies and assesses the value of ultrasound and color Doppler in their diagnoses. Patients and Methods: Six patients with vascular or suspected vascular anomalies seen between 1997 and 1999 composed the study group. All patients were clinically evaluated, imaged by CT with contrast and/or MRI with contrast, ultrasound, and Doppler (including color, spectral, and power). Ultrasound studies were performed in the presence of the referring oral and maxillofacial surgeons to provide consultation on anatomy and differential diagnosis as well as to witness the dynamic study. Three patients were further studied by angiography. The Mulliken/Glowacki classification (Plast Reconstr Surg 69:412, 1982) and designations and the Jackson et al modification (Plast Reconstr Surg 91:1216, 1993) are used in this study. Results: A spectrum of lesions emerged in this small case series. Detailed clinical and imaging findings and a summary of diagnostic impressions allowed general and specific observations and permitted assessment of the value of ultrasound and color Doppler in the diagnosis of these lesions. The diagnostic accuracy of ultrasound and Doppler was equal to or better than that of CT and/or MRI in 4 of 6 cases. In the other 2 cases ultrasound did not specifically diagnose the lesions but did allow assessment of vascularity. In one of these cases the correct diagnosis was made by a combination of CT and angiography, and in the other the diagnosis was made by nonenhanced MRI. An ancillary study showed that the combination of nonenhanced MRI with ultrasound and Doppler provides more information than contrast-enhanced MRI alone and is more cost effective. Conclusions: 1) A single imaging modality is frequently unable to provide sufficient diagnostic information to allow confident clinical management of a vascular malformation. 2) A team approach and conferencing between imaging specialists and clinicians promote better diagnosis and management. 3) Nonenhanced MRI with ultrasound/color Doppler can be substituted for enhanced MRI to provide the best diagnostic information and at reduced cost. 4) Ultrasound/color Doppler is an important adjuvant to CT and MRI in the diagnosis of vascular or suspected vascular anomalies. © 2003 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 61:19-31, 2003
Extensive facial vascular malformations and haemangiomas: A review of the literature and case reports
1997, Journal of Cranio-Maxillo-Facial Surgery
We present 6 selected cases of extensive facial vascular anomalies extending to the skull base or actually involving it. These patients are compared with other cases in the literature. The spontaneous course of these vascular lesions is different and so variable treatment modalities are suggested depending on the age of the patient and the type of lesion. In young children, haemangiomas are common and spontaneous involution is characteristic. Conservative treatment in the sense of a wait-and-see approach is thereby favoured if these is no urgent indication such as involvement of essential structures, e.g. blockage of an orifice as demonstrated in one case or complications such as excessive bleeding.
Vascular malformations most commonly appear in adults, there is no tendency to spontaneous involution and resection is usually necessary, especially in arteriovenous malformations. Nowadays, preoperative superselective embolization is recommended to minimize intraoperative blood loss. Superselective embolization is the treatment of choice in cases of a-v fistulae. Proximal ligation of the supplying arteries should be avoided because this may make embolization more difficult, and may be responsible for the common occurrence of rapid revascularization.
MR angiography and MR imaging of symptomatic vascular malformations
1997, Clinical Radiology
To define the appearance of peripheral vascular malformations at magnetic resonance angiography (MRA) and assess the role of magnetic resonance imaging (MRI) and MRA in the investigation of these lesions.
Fourteen patients (aged 8–51 years) with clinical evidence of a vascular malformation were referred for MRI and MRA, performed on a 0.5 T GE Vectra superconducting system (International General Electric, Slough, UK). Multisection T1-weighted spin-echo and T2-weighted fast spin-echo pulse sequences were performed, with an inversion recovery fast spin-echo sequence in two cases. Two-dimensional time of flight (2-D TOF) and/or 2-D phase contrast (PC) MRA was performed in 13 cases. Eleven patients had digital subtraction angiography (DSA) using a Phillips Integris V3000 digital angiographic unit. The findings at MRA and MRI were compared with the catheter angiograms, and the effective diagnostic input of MRA and MRI was determined.
MRA demonstrated major feeding vessels and multiple intra-lesional vessels in relation to the high flow lesions, features absent in the low flow lesions. However, small feeding vessels to the AVMs were not clearly identified. MRI gave a clear demonstration of the anatomical extent of all lesions. AVMs (n = 6) and venous malformations (n = 6) were reliably distinguished, the former containing multiple serpentine signal voids on T1- and T2-weighted imaging, the latter being hyperintense to fat on T2-weighted images. Two other high-flow lesions diagnosed clinically as vascular malformations appeared solid on MRI, and were diagnosed histologically as a carotid body tumour and an angiomyolipoma.
Although 2-D TOF MRA can distinguish AVMs from venous malformations, the technique adds little extra practical information to the diagnostic process, and cannot compete with catheter angiography for the detailed demonstration of AVM feeding vessels. These lesions can also be characterized using spin-echo sequences, though the primary role of MRI is to demonstrate their anatomical extent.
Venous thromboembolism in pediatric vascular anomalies
2017, Frontiers in Pediatrics

View all citing articles on Scopus

View full text

Clinical articleUse of doppler color flow imaging for differential diagnosis of vascular malformations: A preliminary report

Abstract

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

Oral Surg Oral Med Oral Pathol

Oral Surg Oral Med Oral Pathol

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Oral Maxillofac Surg

J Craniomaxillofac Surg

J Craniomaxillofac Surg

Oral Surg

Clinical article
Use of doppler color flow imaging for differential diagnosis of vascular malformations: A preliminary report