Time-resolved contrast-enhanced MRA (TWIST) with gadofosveset trisodium in the classification of soft-tissue vascular anomalies in the head and neck in children following updated 2014 ISSVA classification: first report on systematic evaluation of MRI and TWIST in a cohort of 47 children

• Published in: Clinical radiology 2016-01, Vol.71 (1), p.32-39
• Main Authors: Higgins, L.J, Koshy, J, Mitchell, S.E, Weiss, C.R, Carson, K.A, Huisman, T.A.G.M, Tekes, A
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Contrast Media; Female; Gadolinium; Head - blood supply; Humans; Image Enhancement - methods; Infant; Infant, Newborn; Magnetic Resonance Angiography - methods; Magnetic Resonance Imaging - methods; Male; Neck - blood supply; Organometallic Compounds; Radiology; Vascular Malformations - diagnosis
• ISSN: 0009-9260; 1365-229X
• DOI: 10.1016/j.crad.2015.09.006

Aim To evaluate the relative accuracy of contrast-enhanced time-resolved angiography with interleaved stochastic trajectories versus conventional contrast-enhanced magnetic resonance imaging (MRI) following International Society for the Study of Vascular Anomalies updated 2014-based classification of soft-tissue vascular anomalies in the head and neck in children. Materials and methods Time-resolved angiography with interleaved stochastic trajectories versus conventional contrast-enhanced MRI of children with diagnosis of soft-tissue vascular anomalies in the head and neck referred for MRI between 2008 and 2014 were retrospectively reviewed. Forty-seven children (0–18 years) were evaluated. Two paediatric neuroradiologists evaluated time-resolved MRA and conventional MRI in two different sessions (30 days apart). Blood-pool endovascular MRI contrast agent gadofosveset trisodium was used. Results The present cohort had the following diagnoses: infantile haemangioma ( n= 6), venous malformation (VM; n= 23), lymphatic malformation (LM; n= 16), arteriovenous malformation (AVM; n= 2). Time-resolved MRA alone accurately classified 38/47 (81%) and conventional MRI 42/47 (89%), respectively. Although time-resolved MRA alone is slightly superior to conventional MRI alone for diagnosis of infantile haemangioma, conventional MRI is slightly better for diagnosis of venous and LMs. Neither time-resolved MRA nor conventional MRI was sufficient for accurate diagnosis of AVM in this cohort. Conventional MRI combined with time-resolved MRA accurately classified 44/47 cases (94%). Conclusion Time-resolved MRA using gadofosveset trisodium can accurately classify soft-tissue vascular anomalies in the head and neck in children. The addition of time-resolved MRA to existing conventional MRI protocols provides haemodynamic information, assisting the diagnosis of vascular anomalies in the paediatric population at one-third of the dose of other MRI contrast agents.