Department of Radiology, Santi Paolo e Carlo Hospital Medical School, University of Milan, Milan, Italy.
Department of Pediatric Radiology and Neuroradiology, V. Buzzi Children's Hospital, Milan, Italy.
Pediatr Radiol. 2024 Aug;54(9):1497-1506. doi: 10.1007/s00247-024-05977-7. Epub 2024 Jul 4.
Among low-flow vascular malformations, venous malformations are relatively frequent. The pathological patterns vary in severity and are generally characterized by dilated vessels and low-flow blood that over time can organize into phleboliths. Sometimes small capillary and/or lymphatic vessels may be associated, micro- and/or macro-shunts may form alone or in different combinations, and finally adipose tissue may be interposed between the malformed vessels. Magnetic resonance imaging (MRI) is a crucial examination for confirming venous malformations because it can accurately identify different features of the lesions.
The aim of our study was to compare MRI and histopathological findings of venous malformations in children to assess the possibilities and limitations of MRI.
In a retrospective study, two observers independently evaluated the contrast-enhanced MRI of 26 children with venous malformations. Several radiological parameters were considered and compared with histopathological findings. The agreement between the interobserver radiological evaluation and between histopathological and radiological diagnosis was verified using Cohen's kappa.
MRI interobserver agreement was excellent for micro-shunts and good for the remaining findings. The radiological-pathological agreement was perfect for the presence/absence of phleboliths and of macro-shunts and almost perfect for the presence of intralesional adipose tissue, lymphatic component, and micro-shunts.
MRI in venous malformations can detect the presence of phleboliths, adipose tissue, and lymphatic components with excellent accuracy and good to excellent interobserver agreement. Furthermore, MR angiography can detect micro-shunts in simple and combined venous malformations with substantial agreement with histopathological findings.
在低流量血管畸形中，静脉畸形相对常见。病理模式的严重程度不同，通常表现为扩张的血管和低流量血液，随着时间的推移，这些血液可能会形成静脉石。有时可能会伴有小的毛细血管和/或淋巴管，可能会形成微分流和/或大分流，最后畸形血管之间可能会插入脂肪组织。磁共振成像（MRI）是确认静脉畸形的重要检查，因为它可以准确识别病变的不同特征。
本研究旨在比较儿童静脉畸形的 MRI 和组织病理学表现，评估 MRI 的可能性和局限性。
在一项回顾性研究中，两名观察者独立评估了 26 例静脉畸形儿童的对比增强 MRI。考虑了几个影像学参数，并与组织病理学发现进行了比较。使用 Cohen's kappa 检验验证了观察者之间的放射学评估和组织病理学与放射学诊断之间的一致性。
MRI 观察者间一致性在微分流方面为优秀，在其余发现方面为良好。放射学-病理学一致性在静脉石和大分流的存在/缺失方面为完美，在病变内脂肪组织、淋巴成分和微分流的存在方面为几乎完美。
MRI 在静脉畸形中可以非常准确地检测静脉石、脂肪组织和淋巴成分的存在，并且观察者间的一致性良好至优秀。此外，MR 血管造影可以检测单纯性和混合性静脉畸形中的微分流，与组织病理学发现具有实质性的一致性。
