The role of diagnostic radiologists in the evaluation of vascular anomalies includes review of existing imaging studies and recommendation of any additional diagnostic imaging studies, if any, that are required for a particular patient. The most commonly performed imaging study for vascular anomalies of childhood is magnetic resonance imaging (MRI). More detailed information regarding blood flow is obtained on contrast-enhanced magnetic resonance angiography (MRA). Additional studies which may be helpful in evaluating these vascular lesions include computed tomography (CT) and ultrasound imaging.

Upon review of imaging studies, the radiologist will usually be able to characterize the lesion as high flow (eg., arteriovenous malformation or hemangioma) or low flow (venous malformation or lymphatic malformation). In some instances the imaging findings are indeterminate, and other possibilities such as uncommon vascular tumors must be considered. The findings on imaging studies must be correlated with each patient’s presentation and clinical findings. At the ACH Vascular Anomalies Center, imaging reviews are performed monthly in the setting of our Multidisciplinary Conference.

At Arkansas Children’s Hospital, four pediatric radiologists are on staff who have the special expertise required to evaluate imaging studies in patients with vascular anomalies. All of the radiologists on our tem have experience in performing state-of-the-art techniques in contrast-enhanced MR angiography which are unavailable at many medical centers. At our institution, more invasive imaging studies such as angiography and venography are typically reserved for guidance of upcoming surgical or embolization procedures.

Interventional Radiology

Our interventional radiologists use the imaging tools of radiology to guide treatment procedures for vascular anomalies. The imaging tools most commonly employed are ultrasound and fluoroscopy. Ultrasound, for example, is helpful in locating dilated veins or lymph channels suitable for therapeutic procedures. Fluoroscopy is used to visualize and guide treatment needles and specialized catheters into arteries or veins in order to selectively target the vascular anomaly.

Sclerotherapy involves injecting a medicine into a malformed vein or lymphatic channel, usually under fluoroscopic control. The goal is to injure the inner lining of these channels, leading over time to reduction in the size of the lesion and reduction in the patient’s symptoms.

Embolization is a specialized treatment procedure in which particle substances are injected under fluoroscopic angiogram control to occlude vessels supplying a vascular anomaly. In order to perform embolization procedures, the radiologist must obtain specialized physician training and certification.

At Arkansas Children’s Hospital, three pediatric radiologists have the training and experience required to safely and effectively treat vascular anomalies lesions using these advanced interventional radiology procedures. For intracranial vascular anomalies, we actively collaborate with a neuroradiologist with specialized training in this area who is based at our adult affiliate, the University of Arkansas for Medical Sciences (UAMS).

Radiology Physicians (Arkansas Children’s Hospital and University of Arkansas for Medical Sciences):

*Charles A. James, MD; Mary B. Moore, MD; Sadaf Bhutta, MD; Robert Buchmann, DO; S. Bruce Greenberg, MD; Lonnie B. Wright, MD; Eren Erdem, MD

*Coordinator of Diagnostic Radiology and Interventional Radiology for the Vascular Anomalies Center of Excellence.