Magnetic resonance imaging (MRI) guidance may help the long-term success of treatment of low-flow vascular malformations, according to a new study.

A low-flow vascular malformation is a deforming growth or birthmark composed of enlarged veins. Whereas the majority of vascular malformations remain unchanged throughout a patient's life, others worsen over time and result in disfigurement, functional impairment, or bleeding. The condition can be difficult to treat because veins are poorly defined and send small extensions into nearby tissues that may be unnoticed during conventional therapy.

Under MR imaging, theyre as bright as light bulbs, reported the study co-author Jonathan S. Lewin, M.D., professor of radiology at Johns Hopkins School of Medicine (Baltimore, MD, USA; www.hopkinsmedicine.org). Detecting and delineating these malformed veins becomes extremely simple.

The usual method for treating low-flow vascular malformations is percutaneous sclerotherapy, a minimally invasive treatment in which radiologists inject a sclerosing agent into the malformation, causing the swollen veins to contract. Whereas MRI has previously been utilized to identify vascular malformations and perform follow-up exams after sclerotherapy, this study, which was published in the November 2004 issue of the journal Radiology, showed that it can be safely and effectively used during the procedure.

We can use MR guidance to place the needle, to determine how much therapeutic mixture is needed to fill the malformation, and to monitor the therapeutic agent as it is injected. The real benefit for the patient is the ability to ensure that the entire malformation is being treated, Dr. Lewin said.

Dr. Lewin and coworkers performed MR-guided percutaneous sclerotherapy on 15 patients with low-flow vascular malformations who had been unsuccessfully treated previously. With MRI-guidance, the investigators successfully treated all major symptoms without complications. At the follow-up exam, the targeted regions continued to demonstrate significant shrinkage.

Marrying the unique advantages of interventional MRI imaging to current minimally invasive therapy has tremendous potential advantages in a broad array of procedures, concluded Dr. Lewin.

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