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, 28 (12), 1739-1744

Treatment of Low-Flow Vascular Malformations of the Extremities Using MR-Guided High Intensity Focused Ultrasound: Preliminary Experience

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Treatment of Low-Flow Vascular Malformations of the Extremities Using MR-Guided High Intensity Focused Ultrasound: Preliminary Experience

Pejman Ghanouni et al. J Vasc Interv Radiol.

Abstract

Five patients with painful vascular malformations of the extremities that were refractory to standard treatment and were confirmed as low-flow malformations on dynamic contrast-enhanced magnetic resonance (MR) imaging were treated with MR imaging-guided high intensity focused ultrasound. Daily maximum numeric rating scale scores for pain improved from 8.4 ± 1.5 to 1.6 ± 2.2 (P = .004) at a median follow-up of 9 months (range, 4-36 mo). The size of the vascular malformations decreased on follow-up MR imaging (median enhancing volume, 8.2 mL [0.7-10.1 mL] before treatment; 0 mL [0-2.3 mL] after treatment; P = .018) at a median follow-up of 5 months (range, 3-36 mo). No complications occurred.

Conflict of interest statement

None of the other authors have identified a conflict of interest.

Figures

Figure 1
Figure 1
MR–guided high-intensity focused US treatment of a slow-flow vascular malformation in the medial thigh causing constant right thigh pain, rated as high as 10 of 10 in severity, refractory to medical management and US–guided anesthetic/steroid injection. (a) Axial postcontrast T1-weighted three-dimensional (3D) spoiled gradient recalled (SPGR) fat-suppressed image obtained 3 months before treatment shows an enhancing 1.3 × 1.2 × 5.2-cm mass (arrow) located in the vastus medialis muscle. (b) Axial MR thermometry magnitude image acquired during sonication with the patient in a left lateral decubitus position shows the region of treatment (yellow) around the vascular malformation, with a representative sonication (green rectangle) and beam path (blue hourglass). Temperature is displayed in real time during treatment (in the inset, the red curve represents the single hottest pixel and the green curve represents an average temperature in a 3 × 3-pixel area around the sonication target). The skin interface with the gel pad and water bath in the near field is demarcated (red line). (c) Axial postcontrast T1-weighted 3D SPGR fat-suppressed image acquired immediately after treatment reveals the ablated area of the vascular malformation (arrow), with surrounding inflammatory enhancement. (d) Axial postcontrast T1-weighted 3D SPGR fat-suppressed image obtained 9 months after treatment shows absence of residual vascular malformation at the treatment site (arrow). Pain improved to a score of 4 of 10 in maximum severity.
Figure 2
Figure 2
MR–guided high-intensity focused US treatment of a slow-flow vascular malformation in the medial calf causing intermittent right calf pain, rated as high as 10 of 10 in severity, refractory to medical management and US–guided anesthetic/steroid injection. (a) Axial postcontrast T1-weighted 3D SPGR fat-suppressed image obtained 5 months before treatment shows an enhancing 0.9 × 0.7 × 1.5-cm mass (arrow) located in the medial gastrocnemius muscle. (b) Axial postcontrast T1-weighted 3D SPGR fat-suppressed image acquired immediately after treatment reveals the ablated area of the vascular malformation (arrow), with surrounding inflammatory enhancement. (c) Axial postcontrast T1-weighted 3D SPGR fat-suppressed image obtained 5 months after treatment shows absence of residual vascular malformation at the treatment site (arrow). Pain resolved after treatment.

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