Venous Malformations Sclerotherapy: Outcomes, Patient Satisfaction and Predictors of Treatment Success

Khaitovich, Boris; Kalderon, Elinor; Eifer, Michal; Raskin, Daniel; Rimon, Uri

doi:10.1007/s00270-019-02338-y

Cited by 18 publications

(14 citation statements)

References 21 publications

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“…The size of a VM is an important factor in sclerotherapy: the larger the VM is, the more sclerosant and greater number of sessions are needed 19 . However, there was no association between the VM volume and treatment response in a study of sclerotherapy for VMs by Khaitovich et al 2 Caty et al 8 reported that evaluation of VM volume using MRI was more sensitive than diameter measurement for detecting size variation and responses to sclerotherapy. Similarly, VM volume was not a good predictor of the long‐term response to treatment in this study.…”

Section: Discussionmentioning

confidence: 99%

Value of Dynamic Contrast‐Enhanced (DCE) MRI in Predicting Response to Foam Sclerotherapy of Venous Malformations

Xia

Yuan

et al. 2021

Magnetic Resonance Imaging

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Background Preoperative imaging assessment of venous malformations (VMs) and prediction of foam sclerotherapy efficacy might be achievable by DCE‐MRI but elaborate quantitive analysis was absent. Purpose To evaluate the value of DCE‐MRI in predicting the effectiveness of foam sclerotherapy in VMs. Study Type Retrospective. Population Fifty‐five patients (M:F = 17:38; mean age ± SD, 15.4 ± 13.0 years) with VMs. Field Strength/Sequence Three Tesla MRI with 3D T1‐weighted volume interpolated body examination. Assessment Patients who underwent pretreatment DCE‐MRI were divided into “effective” and “ineffective” groups according to the response to foam sclerotherapy. Clinical characteristics and morphologic features were assessed. The semiquantitative parameters, such as maximum intensity time ratio (MITR), enhancement ratio (ER), and Slope, were obtained from ROI and volume of interest (VOI). The quartile and mean values of these parameters were acquired from VOI, while mean values denoted as Mean# were acquired from ROI. Establishment of two predictive models was based on ROI and VOI respectively. Model 1 was based on morphologic parameters and ROI semiquantitative parameters, while model 2 was based on morphologic parameters and VOI semiquantitative parameters. Statistical Analysis Mann–Whitney U‐test, Cohen's kappa, multivariate logistic regression analysis (backward stepwise), and ROC analyses. Results The lesion classification, presence of phlebolith, semiquantitative parameters of VOI (quartile and mean of MITR), and semiquantitative parameters of ROI (Slopemean#, MITRmean#) were significantly different between two groups. Lesion classification (P = 0.002) and MITRmean# (P = 0.027) were independent predictors for poor efficacy in model 1 as determined by multivariate binary logistic regression analysis. For model 2, lesion classification (P = 0.006) and MITR25 (P = 0.001) were independent predictors. The predictive model based on VOI (AUC = 0.961) performed better than that based on ROI (AUC = 0.909) in predicting therapeutic response. Data Conclusion DCE‐MRI is promising in predicting the response to foam sclerotherapy for VMs. The whole lesion VOI‐based model showed better performance and could instruct surgical approach in the future. Evidence Level 3 Technical Efficacy Stage 4

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Section: Discussionmentioning

confidence: 99%

Value of Dynamic Contrast‐Enhanced (DCE) MRI in Predicting Response to Foam Sclerotherapy of Venous Malformations

Xia

Yuan

et al. 2021

Magnetic Resonance Imaging

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“…Although PS is an established therapy method for the treatment of VMs of the head and neck region, an objective pre- and post-treatment evaluation by MRI has not been comprehensively reported in the literature [ 8 , 11 , 13 , 14 , 24 ]. In most studies, the only parameter for assessment of the size of the VM was the maximum diameter of the lesion [ 4 , 13 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies investigated the efficacy of PS regarding the patient’s symptoms and the volume change of the VMs. In a recent study published Khaitovich et al including 309 patients with VMs throughout the whole body, complete symptom relief ranged between 12% and 23% (depending on the type of symptom) [ 8 ]. Specific MRI-based lesion analyses, however, were not performed.…”

Section: Discussionmentioning

confidence: 99%

“…Common symptoms include cosmetic disfigurement, pain and compression of adjacent anatomical structures. Percutaneous sclerotherapy (PS) is one of the most established treatment methods in combating those symptoms [ 7 , 8 ]. The aim of this therapy is to induce sterile inflammatory reactions, involving the endothelium, which finally leads to occlusion of the affected vessels and involution of the vascular malformation [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Image-guided percutaneous sclerotherapy of venous malformations of the head and neck: Clinical and MR-based volumetric mid-term outcome

et al. 2020

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Objective To report the clinical and MRI-based volumetric mid-term outcome after image guided percutaneous sclerotherapy (PS) of venous malformations (VM) of the head and neck. Methods A retrospective analysis of a prospectively maintained database was performed, including patients with VM of the head and neck who were treated with PS. Only patients with available pre- and post-interventional MRI were included into this study. Clinical outcome, which was subjectively assessed by the patients, their parents (for paediatric patients) and/or the physicians, was categorized as worse, unchanged, minor or major improvement. Radiological outcome, determined by MRI-based volumetric measurements, was categorized as worse (>10% increase), unchanged (≤10% increase to <10% decrease), minor (≥10% to <25% decrease), intermediate (≥25% to <50% decrease) or major improvement (≥50% decrease). Results Twenty-seven patients were treated in 51 treatment sessions. After a mean follow-up of 31 months, clinical outcome was worse for 7.4%, unchanged for 3.7% of the patients, while there was minor and major improvement for 7.4% and 81.5%, respectively. In the volumetric imaging analysis 7.4% of the VMs were worse and 14.8% were unchanged. Minor improvement was observed in 22.2%, intermediate improvement in 44.4% and major improvement in 11.1%. The rate of permanent complications was 3.7%. Conclusion PS can be an effective therapy to treat the symptoms of patients with VMs of the head and neck and to downsize the VMs. MRI-based volumetry can be used to objectively follow the change in size of the VMs after PS. Relief of symptoms frequently does not require substantial volume reduction.

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“…Most follow-ups are clinical and on US, and "patient satisfaction" has been traditionally considered a good indicator of the therapeutic outcome, apart from the anatomical and clinical corrections [18,118,120,124] (Fig. 24).…”

Section: Expected Outcomes Of Sclerotherapymentioning

confidence: 99%

Image-Guided Percutaneous Injection Sclerotherapy of Venous Malformations

Kumar

Bhavana

Sinha

et al. 2020

SN Compr. Clin. Med.

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Venous malformations (VM) are the commonest types of vascular malformations, with an appropriate clinico-radiological diagnostic pathway being critical for establishing the correct diagnosis, mapping the extent of disease and involvement of important structures, guiding appropriate therapy, and predicting prognosis. Ultrasound (US) with color Doppler examination is the first-line radiological investigation with magnetic resonance imaging being used for further evaluation, providing the exact lesion extent and involvement of muscles, bones, and neurovascular bundles. Direct puncture phlebography of the lesion confirms the diagnosis and classifies the lesion in four types. Type 1 is an isolated malformation without peripheral drainage, type 2 malformation drains into normal veins, type 3 malformation drains into dilated veins, and type 4 malformation represents dysplastic venous ectasia. Treatment is sought for cosmetic reasons, pain, and functional issues. Sclerotherapy is the first-line treatment and image guidance, either US or phlebographic, is employed for the same. Various techniques are described including double or multiple puncture technique, subtraction-guided technique, filling defect technique, or a combination of these. Various sclerosants have been used including dry ethanol, polidocanol, ethanolamine oleate, sodium tetradecyl sulfate, sodium morrhuate, OKC 432, bleomycin, and doxycycline, either in liquid form or as microfoam prepared using Tessari's technique. Typically, multiple sessions are needed and the lesions may recur; however, overall response rate, quality of life improvement, and patient satisfaction are significantly improved. Local complications like pain, swelling, and ulcerations are common. Major complications of sclerotherapy are infrequent; however, pulmonary embolism, stroke, vision loss, compartment syndrome, tissue necrosis, hemolysis, anaphylaxis, nerve palsy, and pulmonary complications do occur and the patient and treating physicians should be aware of.

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Venous Malformations Sclerotherapy: Outcomes, Patient Satisfaction and Predictors of Treatment Success

Cited by 18 publications

References 21 publications

Value of Dynamic Contrast‐Enhanced (DCE) MRI in Predicting Response to Foam Sclerotherapy of Venous Malformations

Value of Dynamic Contrast‐Enhanced (DCE) MRI in Predicting Response to Foam Sclerotherapy of Venous Malformations

Image-guided percutaneous sclerotherapy of venous malformations of the head and neck: Clinical and MR-based volumetric mid-term outcome

Image-Guided Percutaneous Injection Sclerotherapy of Venous Malformations

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