Whole-lesion assessment of volume and signal changes after sclerotherapy of extremity venous malformations

Adham Khalil; Amanda Laguna; Tej I Mehta; Prateek C Gowda; Anna J Gong; Robert M Weinstein; Tushar Garg; Natalie Y Ring; Ryan W England; Marius George Linguraru; Craig K Jones; Clifford R Weiss

doi:10.1016/j.ejrad.2024.111397

Whole-lesion assessment of volume and signal changes after sclerotherapy of extremity venous malformations

Eur J Radiol. 2024 May:174:111397. doi: 10.1016/j.ejrad.2024.111397. Epub 2024 Mar 1.

Authors

Affiliations

¹ Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Surgery, Medstar Georgetown University Hospital, Washington, DC.
² The Warren Alpert Medical School of Brown University, Providence, RI, USA.
³ Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA; United States Air Force Medical Corps, Falls Church, VA, USA.
⁴ The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁵ Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
⁶ Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA; School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
⁷ Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Computer Science, The Johns Hopkins University, Baltimore, MD, USA; The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, USA. Electronic address: craigj@jhu.edu.
⁸ Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA; The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, USA.

PMID: 38452733
DOI: 10.1016/j.ejrad.2024.111397

Abstract

Purpose: To investigate quantitative changes in MRI signal intensity (SI) and lesion volume that indicate treatment response and correlate these changes with clinical outcomes after percutaneous sclerotherapy (PS) of extremity venous malformations (VMs).

Methods: VMs were segmented manually on pre- and post-treatment T2-weighted MRI using 3D Slicer to assess changes in lesion volume and SI. Clinical outcomes were scored on a 7-point Likert scale according to patient perception of symptom improvement; treatment response (success or failure) was determined accordingly.

Results: Eighty-one patients with VMs underwent 125 PS sessions. Treatment success occurred in 77 patients (95 %). Mean (±SD) changes were -7.9 ± 24 cm³ in lesion volume and -123 ± 162 in SI (both, P <.001). Mean reduction in lesion volume was greater in the success group (-9.4 ± 24 cm³) than in the failure group (21 ± 20 cm³) (P =.006). Overall, lesion volume correlated with treatment response (ρ = -0.3, P =.004). On subgroup analysis, volume change correlated with clinical outcomes in children (ρ = -0.3, P =.03), in sodium tetradecyl sulfate-treated lesions (ρ = -0.5, P =.02), and in foot lesions (ρ = -0.6, P =.04). SI change correlated with clinical outcomes in VMs treated in 1 PS session (ρ = -0.3, P =.01) and in bleomycin-treated lesions (ρ = -0.4, P =.04).

Conclusions: Change in lesion volume is a reliable indicator of treatment response. Lesion volume and SI correlate with clinical outcomes in specific subgroups.

Keywords: Magnetic resonance imaging; Sclerotherapy; Segmentation; Venous malformation, extremity; Volumetric analysis.

MeSH terms

Child
Humans
Retrospective Studies
Sclerosing Solutions / therapeutic use
Sclerotherapy*
Treatment Outcome
Vascular Malformations* / diagnostic imaging
Vascular Malformations* / therapy
Veins

Substances

Sclerosing Solutions