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MR-guided percutaneous sclerotherapy of low-flow vascular malformations: Clinical experience using a 1.5 tesla MR
Daniel M O'Mara1, Paul A DiCamillo2, Wesley D Gilson3
1Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Purpose:
To demonstrate the feasibility, safety, and effectiveness of image-guided sclerotherapy of low-flow vascular malformations using a 1.5 Tesla (T) MR scanner with real-time imaging capability and in-suite fluoroscopy.
Materials And Methods:
Thirty-three procedures were performed with real-time 1.5T MR-guidance on 22 patients with a vascular malformation in the neck (n = 2), chest (n = 6), abdomen and pelvis (n = 15), and extremities (n = 11). Quantitative analysis was performed for changes in (a) planning time, (b) targeting time (interval between needle skin puncture and lesion access), (c) intervention time (interval between needle skin puncture and needle removal), and (d) total procedure time. Qualitative analysis was performed for (a) success of therapy and (b) occurrence of complications.
Results:
Technical success was achieved in 29 of 33 procedures. The average planning time did not significantly change between the first seven procedures and the last seven procedures (P = 0.447). The average targeting time decreased by 0:24:45 (hours:minutes:seconds) (P = 0.043), the average intervention time decreased by 0:26:58 (P = 0.022), and the average procedure time decreased by 0:28:41 (P = 0.046) when comparing the first seven procedures and the last seven procedures. Overall, there was an improvement in the patients' predominant symptoms following 82% of procedures, including a significant decrease in average pain following therapy (P < 0.001). There was a minor complication rate of 3% with no major complications.
Conclusion:
MR-guided percutaneous sclerotherapy seems to be a safe, effective, and versatile technique for treating low-flow vascular malformations.
Level Of Evidence:
3 J. Magn. Reson. Imaging 2017;45:1154-1162.
Insights
Image-guided sclerotherapy using 1.5T MR is a safe and effective treatment for low-flow vascular malformations. This technique significantly reduces procedure times and improves patient symptoms with a low complication rate.
Area of Science:
- Medical Imaging
- Interventional Radiology
- Vascular Surgery
Background:
- Low-flow vascular malformations present diagnostic and therapeutic challenges.
- Image guidance is crucial for precise intervention in vascular lesions.
Purpose of the Study:
- To assess the feasibility, safety, and effectiveness of 1.5 Tesla (T) MR-guided sclerotherapy for low-flow vascular malformations.
- To evaluate the impact of real-time MR guidance on procedure efficiency and patient outcomes.
Main Methods:
- Thirty-three sclerotherapy procedures were performed on 22 patients using real-time 1.5T MR guidance and in-suite fluoroscopy.
- Quantitative analysis of planning, targeting, intervention, and total procedure times.
- Qualitative assessment of therapeutic success and complication rates.
Main Results:
- Technical success was achieved in 29 of 33 procedures (88%).
- Significant reductions were observed in targeting time (P=0.043), intervention time (P=0.022), and total procedure time (P=0.046) with experience.
- 82% of patients experienced improvement in predominant symptoms, with a significant decrease in pain (P<0.001).
- A minor complication rate of 3% was recorded, with no major complications.
Conclusions:
- MR-guided percutaneous sclerotherapy is a safe and effective modality for treating low-flow vascular malformations.
- The technique demonstrates versatility across various anatomical locations.
- Real-time MR guidance enhances procedural efficiency and patient symptom management.
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