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Table 1 Characteristic imaging features of vascular malformations

From: Imaging of peripheral vascular malformations — current concepts and future perspectives

Malformation type All imaging modalities (diagnostic value in flow-characteristics) MRI features Ultrasound
Slow-flow VM Ultrasound (3)
CDUS/CEUS (1/3)
X-ray (1)
MRI and MRV (3)
Transvenous phlebography (3)
Septated lobulated mass without mass effect
Phleboliths (low SI), fluid-fluid levels, low SI on T1WI, high SI on T2WI
No flow voids on SE images
Infiltrates tissue planes and possible surrounding oedema
No arterial or early venous enhancement
Slow gradual enhancement and diffuse enhancement on delayed images with some late enhancement (≥ 5 s)
Normal afferent arteries
Contrast pooling in dilated stagnant venous spaces in later venous phase imaging
Variable appearance (spongiform, multicystic, uncommon as dilated tubular channels)
Usually heterogeneous, mostly hypoechoic intralesional phleboliths (calcifications) may be present
Localized or involving multiple soft-tissue planes
Spontaneous echo contrast, absence of spontaneous flow, luminal filling, and venous flow pattern detectable with provocative maneuvers (proximal or distal compression)
Slow-flow LM Ultrasound (3)
MRI (2)
Septated lobulated mass with some fluid–fluid levels
Infiltration of tissue planes
Low SI on T1WI, high SI on T2WI
No flow voids on SE images
Rim and septal enhancement
No significant or slight diffuse enhancement
Macrocystic:
Multicystic with thin septa
Variable echogenicity of cystic contents, sometimes with fluid-fluid levels, especially if complicated with hemorrhage
No flow or low vascular density on color Doppler, confined to septa
Microcystic:
Ill-defined and hyperechoic, containing scattered cysts < 1–2 cm
Sometimes no visible cysts
No flow or low vascular density on color Doppler
High-flow AVM Ultrasound (1)
CDUS/CEUS (3/3)
MRI and MRA (2)
Perfusion CT with CTA (3)
Catheter angiography (3)
No well-defined mass
Infiltration of tissue planes
Flow voids on SE images
Enlarged feeding arteries and draining veins
Hypertrophied tortuous afferent arteries and efferent veins
Direct arteriovenous communications via vascular nidus
Early enhancement of arteriovenous lesion (≤ 5 s)
Early enhancement of enlarged feeding arteries and nidus with shunting to draining veins
Conglomerate of tortuous, dilated vessels without discrete mass that can involve multiple soft-tissue planes
Pulsatile flow with high velocities, low resistance, and spectral broadening
  1. Diagnostic value: 1, moderate; 2, good; 3, high