Kanthawang Thanat, Hirun Yuttapol, Unsrisong Kittisak, Vongsfak Jirapong, Vuthiwong Withawat
Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Neurosurgery Unit, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
J Clin Med. 2025 Jun 25;14(13):4505. doi: 10.3390/jcm14134505.
This study aims to identify baseline imaging parameters, across various imaging modalities, that can predict the response to bleomycin sclerotherapy in patients with head and neck lymphatic-venous malformations (LVMs). A retrospective analysis of 80 patients (85 lesions) treated at a tertiary care center between January 2018 and December 2022 was conducted. Imaging modalities, including CT, MRI, ultrasonography, and dynamic digital radiographic images, were reviewed for lesion characteristics. Factors including lesion type, volume, morphology, location, and contrast opacification patterns were analyzed for their association with treatment response, defined as a >50% reduction in lesion size and symptom improvement. Univariable and multivariable logistic regression analyses were performed. Of 85 lesions, 45 (52.9%) responded to treatment. Univariable analysis showed that pure lymphatic malformations (OR = 6.12, = 0.004), macrocystic components (OR = 10, = 0.016), cavitary morphology on dynamic digital radiographic images (OR = 8.90, < 0.001), neck location (OR = 4, = 0.03), and deep-seated lesions (OR = 3.69, = 0.03) were significantly associated with better outcomes. Multivariable analysis identified cavitary morphology as the strongest predictor ( = 0.04). A combination of cavitary morphology, macrocystic components, and pure LM type yielded the highest predictive accuracy (AUC = 0.80, = 0.03). The presence of lymphatic channels or large cystic venous spaces-such as macrocystic features on imaging or cavitary morphology-along with neck or deep-seated lesion location, predicts a favorable response to bleomycin sclerotherapy in head and neck LVMs.
本研究旨在确定各种成像模态下的基线成像参数，这些参数可预测头颈部淋巴静脉畸形（LVM）患者对博来霉素硬化治疗的反应。对2018年1月至2022年12月在一家三级医疗中心接受治疗的80例患者（85个病灶）进行了回顾性分析。对包括CT、MRI、超声和动态数字X线影像在内的成像模态进行了病灶特征评估。分析了病灶类型、体积、形态、位置和对比剂充盈模式等因素与治疗反应的相关性，治疗反应定义为病灶大小减少>50%且症状改善。进行了单变量和多变量逻辑回归分析。85个病灶中，45个（52.9%）对治疗有反应。单变量分析显示，单纯性淋巴管畸形（OR = 6.12，P = 0.004）、大囊成分（OR = 10，P = 0.016）、动态数字X线影像上的空洞形态（OR = 8.90，P < 0.001）、颈部位置（OR = 4，P = 0.03）和深部病灶（OR = 3.69，P = 0.03）与更好的治疗结果显著相关。多变量分析确定空洞形态是最强的预测因素（P = 0.04）。空洞形态、大囊成分和单纯性淋巴管畸形类型的组合产生了最高的预测准确性（AUC = 0.80，P = 0.03）。成像上的淋巴管或大囊性静脉间隙（如大囊特征或空洞形态）以及颈部或深部病灶位置的存在，预示着头颈部LVM对博来霉素硬化治疗有良好反应。
