Angiographic criteria for differential diagnosis of hemangiomas and arteriovenous malformations of different localization

Abstract

Hemangiomas and microfistular arteriovenous malformations (AVMs) are vascular anomalies with high blood flow velocity. On angiographic examination, they look the same, in the form of a contrasting spot of varying degrees of intensity. A comparative analysis of the angiographic picture in dynamics, during the performance of subtraction angiography, allows for differential diagnosis and clearly identifies the type of vascular anomaly. Objective. to develop effective angiographic criteria for the differential diagnosis of hemangiomas and microfistular arteriovenous malformations (AVM) using subtraction angiography. Material and methods. Subtraction angiography of patients with congenital vascular anomalies based on 27 studies. Results. Analysis of angiographic data, performed in the subtraction mode, made it possible to identify characteristic angiographic differences between microfistular arteriovenous malformations and hemangiomas. The angiographic picture was studied in dynamics. The time between the onset of the arterial and venous contrasting phases, the duration of the parenchymal contrasting phase was calculated. In AVMs, outflow veins appear on the angiogram already in the first second of contrasting arteries due to rapid drainage of contrast through arteriovenous fistulas. The duration of contrasting the AVM shadow is no more than 2–3 seconds. Contrasting of the hemangioma parenchyma appears in the arterial phase at 2–3rd seconds and lasts for a long time from 3 to 10 seconds, due to a prolonged delay of the contrast medium in the cavernous structures of the hemangioma with late appearance of outflow veins. Conclusions. Performing and analyzing subtraction angiography in patients with congenital vascular anomalies allows instant differential diagnosis between hemangiomas and microfistular arteriovenous malformations without using additional examination methods. This increases the efficiency and quality of diagnostics of patients with vascular abnormalities, allows you to immediately transfer the diagnostic procedure to endovascular surgery. It makes the possible to provide specialized medical care to patients with hemangiomas and AVMs in one session, without additional endovascular intervention. Key words: hemangioma, arteriovenous malformation, differential diagnosis, angiography.