Echolucent carotid plaque MRI for vascular imaging gor with restenosis after carotid endarterectomy. Publication types Review. Prior studies have uncovered an association between these ASL-based measures and PAD disease presence and severity Wu et al.

MRI for vascular imaging -

HAVS in a year-old man. a Coronal T2-weighted MR image showing isolated osteoarthritis of the radioscaphoid compartment of the radiocarpal joint.

b Contrast-enhanced T1-weighted fat-suppressed sequence showing a focal occlusion at the junction of the UA and the SPA straight arrow and a tenosynovitis of the flexor digitorum tendons curved arrow.

The UA was otherwise preserved. HAVS is substantially underrecognised. This underdiagnosis is problematic because early recognition and management of this condition are crucial for preventing progression and improving prognosis.

Management involves reduction of vibration exposure, avoidance of cold conditions, smoking cessation, and medication. The persistent median artery may be the site of an occlusion or an aneurysm that causes carpal tunnel syndrome Fig.

This pathology is rare and its mechanism is unclear. Persistent median artery occlusion in a year-old woman. Axial T2-weighted MR image showing an occlusion of the persistent median artery straight arrow and a bifid median nerve arrowheads. Note also the small median artery satellite veins dotted arrows.

Arterial complications result from inadvertent and often repeated arterial puncture during attempted venous access and can lead to acute vascular emergencies. Vascular complications are common in people who inject drugs.

They can occur locally at the injection site or at a distant location and may be arterial or venous in nature [ 49 ]. Various offending agents have been described, including temazepam, flunitrazepam, zolpidem, heroin, midazolam, cocaine, and buprenorphine [ 51 ].

Crushed pills lead to a significantly higher incidence of amputation compared with pure drug substances [ 50 ].

Associated infections are common and represent a poor prognostic factor. A multimodal imaging strategy is often required in the assessment of these vascular complications, typically involving a combination of ultrasound and CT Fig. Vascular complications may manifest as injury to the vessel wall, pseudoaneurysm or arterial thrombosis with resultant ischaemia or haematogenous spread of a pathogen from the injection site.

CT is the imaging modality of choice for mycotic aneurysms. Gas within the aneurysm is a rare but characteristic sign, which is best seen on CT. Additional imaging features more commonly seen on CT include a lobulated vascular mass, an irregular and poorly defined arterial wall, peri-aneurysmal soft tissue stranding, and oedema.

In addition to the risk of rupture, mycotic aneurysms may also lead to the development of arteriovenous fistulae or serve as a source of sepsis or septic emboli [ 49 ]. Thrombolysis and surgical revascularisation may be indicated to restore blood flow to ischaemic tissues in the hand.

Pseudoaneurysm of the RA arrow , after intra-arterial injection of buprenorphine, demonstrated with CTA. It typically affects young male smokers younger than 45 years. Cannabis use has also been implicated. This disease primarily affects small- and medium-sized arteries and veins in the upper and lower extremities, usually beginning in the small distal vessels, resulting in distal ischaemia.

As the disease progresses, it may involve more proximal arteries. Superficial venous thrombosis is also a typical finding. CTA, MRA, or angiography shows involvement of the small- and medium-sized vessels in the upper and lower extremities, including the palmar and plantar arches, the RA and UA, and the digital arteries of the fingers Fig.

The most common imaging findings are segmental occlusive lesions with bridging or corkscrew collaterals around the areas of occlusion. The disease tends to be more severe distally, with interspersed normal vessels. There should be no evidence of atherosclerosis or other proximal source of emboli e.

dissections or aneurysms [ 53 ]. Vasodilator therapy with iloprost should be considered in acute phases, and bypass surgery may be indicated for limb salvage in critical ischaemia. SSc is a rare multisystemic disease that preferentially affects middle-aged women.

Ischaemic digital ulcers may be responsible for major disability. Although rarely indicated for the evaluation of patients affected by SSc, vascular involvement as well as bone and other soft tissue lesions can be identified on CTA or MRA. Systemic vasculitides affecting the hand are mostly represented by polyarteritis nodosa PAN.

PAN is a systemic necrotising vasculitis that typically affects medium-sized arterial vessels but may also affect small-sized arterial vessels.

PAN is usually diagnosed in middle-aged and older adults. Systemic symptoms can be the only complaints but almost every organ can be involved. Characteristic lesions of the hand include multiple short segment stenoses of the proper and common digital arteries, ectasia, and aneurysms with thickening of the vessels [ 3 ].

Similar findings have been reported for granulomatosis with polyangiitis and eosinophilic granulomatosis with polyangiitis and microscopic polyangiitis. Hand tumours are encountered frequently. Lesions with a vascular origin comprise a wide and heterogeneous spectrum of injuries.

The International Society for the Study of Vascular Anomalies ISSVA classification distinguishes between vascular tumours lesions with cell proliferation and vascular malformations due to an innate disruption of vascular morphogenesis with different pathogenesis, prognosis, and treatment [ 55 , 56 ].

Vascular malformations are classified into low-flow malformations lymphatic, capillary, or most often venous and high-flow malformations arteriovenous fistula and arteriovenous malformation AVM. The soft tissue tumours are classified according to the ISSVA and the World Health Organisation WHO classification of soft tissue tumours [ 57 ].

Some ambiguities still persist because some of these lesions might be classified as tumours or pseudo-tumours and malformations. In addition, tumours and malformations may also be associated. Furthermore, the current WHO classification of soft tissue tumours recognises three perivascular pericytic tumour types: glomus tumours, myopericytoma, and angioleiomyoma [ 57 ].

MRI provides valuable information for the assessment and treatment of these lesions. Firstly, MRI can determine the nature of many of these lesions. MRA can also characterise the flow pattern of the vascular malformations to guide treatment towards trans-arterial embolisation for high-flow malformations and percutaneous embolisation for low-flow malformations.

Finally, MRI is essential to define the anatomic extent and involvement of various tissue layers, a distinct advantage over ultrasound [ 7 ]. Dynamic CTA—due to its higher temporal resolution—is also a valuable technique for the evaluation of high-flow malformations Fig.

It is important to remember that all vascularised lesions do not necessarily have a vascular origin and that histopathologic analysis remains mandatory in most cases [ 6 , 58 , 59 , 60 ].

Vascular malformations of the hand are common. They are frequently responsible for a visible mass or an enlarged finger. Low-flow malformations are much more frequent than high-flow malformations [ 1 , 5 , 7 , 9 , 14 , 26 , 56 , 61 , 62 , 63 , 64 ].

They may affect the skin with a colour change red or blue. The presence of increased warmth, vascular bruit, or thrill suggests a high-flow component.

An AVM is defined by the presence of a nidus. MRA and CTA demonstrate a very rapid lesion enhancement that occurs in the early phases of arterial enhancement, with dilated afferent arteries and early venous drainage through dilated veins.

Flow voids are frequently present on conventional MRI sequences Fig. Arteriovenous fistula is characterised by a connection between an artery and a vein and a dilation and rapid enhancement of the vein involved in the hyperdynamic circulation Fig. Venous and low-flow malformations are uni- or multifocal lesions with variable size that may affect different anatomical structures of different anatomical compartments.

These lesions have a micro- or macrocystic pattern and usually a lobulated appearance, appearing hyperintense on fluid sensitive sequences, without flow voids.

Phleboliths or thrombi may be present in intralesional venous lakes. Afferent arteries are of normal size, and there is no early venous drainage. Contrast enhancement is slow and sometimes very delayed or even absent. On dynamic imaging, the earliest lesion enhancement occurs later than 5 s after arrival of contrast agent in the local arteries [ 1 , 26 , 61 ].

The ISSVA as well as the WHO classification of soft tissue tumours distinguishes between benign vascular tumours, locally aggressive or low metastatic risk intermediate malignant vascular tumours, and malignant vascular tumours [ 55 , 57 , 65 ]. Some of these tumours preferentially affect the hand Table 5.

Pyogenic granuloma or lobular capillary haemangioma is a common benign tumour, usually diagnosed on the basis of its clinical features, although skin biopsies are required to confirm its nature.

Pyogenic granuloma is composed of hyperplastic clusters of capillaries arranged in a lobular architectural pattern. Pyogenic granuloma is a misnomer because the condition is not associated with pyogenic infection and it does not histologically represent a granulomatous inflammation. After an initial rapid growth within a few weeks, its size stabilises and rarely exceeds 2 cm.

It develops in the superficial dermis—or more rarely in the hypodermis—in the mucosal surfaces, and exceptionally in a vein. The superficial lesions take the appearance of a fleshy vascular, friable, and haemorrhagic nodule. These tumours often occur at the site of even minor trauma, a scratch, or an insect bite.

They affect both children and adults. They often accompany pregnancy. The tumour is usually solitary, but disseminated forms exist. Imaging techniques show a small, exophytic, and hypervascular tumour associated with a dramatic increase in the vascular flow of the entire finger Fig.

Pyogenic granuloma of the third finger in a year-old woman who recently gave birth. a Photograph showing fleshy vascular, haemorrhagic exophytic tumour of the distal phalanx, and an enlargement of the finger. b Dynamic CTA showing an increased vascularity of the entire finger associated with a hypervascular exophytic soft tissue tumour.

c Axial T2-weighted MR image showing an exophytic tumour without clear margins associated with oedema and vessels dilations with flow void arrows in the soft tissues.

There are still some controversies whether they should be classified as vascular malformations or vascular tumours. They affect adolescents and young adults, appear rapidly, and never regress spontaneously. They are mostly composed of mixed vessel types, including lymphatics, large thick-walled veins, a mixture of cavernous-like vascular spaces and capillaries, or a prominent arteriovenous component [ 57 ].

IMH usually appears as a lobulated intramuscular hypervascular mass that also contains mature adipose tissue and sometimes phleboliths, thrombi, or metaplastic ossification Fig. These tumours demonstrate an intense enhancement after contrast medium injection, but the vascular flow may be either fast or slow depending upon the vascular composition [ 67 , 68 ].

Intramuscular haemangioma in a year-old man. a, b Axial T1-weighted a and T2-weighted b MR images showing a large mass infiltrating the flexor digitorum profundus muscle, composed of fatty tissue curved arrow and vascular lakes containing thrombi and calcifications straight arrow.

Spindle cell haemangiomas are benign vascular tumours. They present as slowly growing, vascular-appearing, solitary or multiple, dermal or subcutaneous nodules with a predilection for the distal extremities of young adults, especially the hands.

Multifocal lesions can be a manifestation of Maffucci syndrome. Maffucci syndrome is a rare, non-hereditary mesodermal dysplasia caused by somatic mutations of the IDH1 or IDH2 gene; it is characterised by enchondromatosis associated with spindle cell haemangiomas.

The disease begins in childhood with the asynchronous appearance of enchondromas that predominate in the hands and long bones.

Maffucci syndrome in a year-old woman. a Standard radiography showing the typical multiple enchondroma of the bones of the hand. b Axial T2-weighted MR image showing a haemangioma characterised by cavernous vascular spaces containing phleboliths arrow.

IPEH can arise from normal blood vessels primary IPEH or in vascular malformations secondary IPEH. The precise pathogenesis of the disease is still unclear, although it seems to be the response to blood vessel injury or thrombosis.

There is no age predilection. Secondary IPEH mimics the imaging characteristics of the associated vascular lesions Fig.

It is important to correlate imaging findings with histology. Although histological evaluation is the main method for diagnosis, IPEH can histologically simulate angiosarcoma, a malignant tumour with a distinct appearance on MRI [ 70 ].

Secondary intravascular papillary endothelial hyperplasia in a year-old woman taking the aspect of a low-flow vascular malformation affecting the thenar eminence. Axial T2-weighted MR image showing a polylobular mass with multiple cavernous lakes containing phleboliths.

Epithelioid haemangioma also called angiolymphoid hyperplasia with eosinophilia, inflammatory angiomatous nodule, or atypical pyogenic granuloma is a benign vascular tumour reported at diverse anatomic locations including the skin and arteries.

These tumours mostly affect men and show a predilection for the extremities. They may also arise within the walls of peripheral medium-sized muscular arteries, such as the UA or RA.

MRI usually shows a tumour with focal intramural growth of the affected vessel Fig. It is noteworthy that these tumours may also mimic a focal arterial aneurysmal dilatation, a malignant vascular neoplasm, or a classic epithelioid sarcoma.

Classic or distal epithelioid sarcoma is a malignant mesenchymal neoplasm that affects adolescents and young adults. Classic epithelioid sarcoma commonly occurs in the distal upper extremity and affects mainly volar surfaces of the hand, and CT or MRI demonstrates a multinodular mass that extends along vessels, nerves, and fascial planes [ 57 ].

Epithelioid haemangioma of the RA. Axial T2-weighted MR image showing a hypervascular tumour arising from the arterial wall of the RA associated with narrowing of the vessel lumen arrow.

It mainly affects adult men. There are four clinical—epidemiological forms: classic Mediterranean, endemic or African, iatrogenic frequently in transplanted patients , and epidemic associated with HIV infection. The causative agent is human herpes virus-8 HHV-8 , which has a particular tropism for endothelial cells and is found in all cases.

The appearance of skin lesions varies from a simple purplish plaque sometimes resembling a haematoma to an ulcerated tumour. Lymphoedema may be present. Aggressive forms are associated with invasion and destruction of the underlying soft tissue and skeleton.

CTA and MRA demonstrate hypervascular round or oval nodules with skin thickening. a Standard radiography showing bone lytic tumours of the radius, scaphoid, and trapezoid bones. b , c Axial T2-weighted MR images showing a small cutaneous tumour of the palm straight arrow , a tumour invading the scaphoid bone curved arrow and soft tissue infiltration.

Angiosarcoma is an aggressive, malignant endothelial cell tumour of lymphatic or vascular origin. Angiosarcoma of the hand can be divided into primary cutaneous angiosarcoma and secondary angiosarcoma, associated with chronic lymphoedema Stewart—Treves syndrome or radiation therapy Fig.

They may also originate from Maffucci syndrome or haemangioma. MRI shows an irregular, highly vascularised mass with foci of haemorrhage, vessels in the tumour, and invasion of the surrounding tissues.

It may also appear as small cutaneous or subcutaneous nodules or take the appearance of a pseudoaneurysm. Stewart—Treves syndrome in a year-old woman with a history of mastectomy with axillary lymph node dissection for breast cancer and chronic lymphoedema.

Axial T2-weighted MR image showing a skin exophytic tumour developing at the palm of the wrist corresponding to an angiosarcoma arrow. Note also the subcutaneous infiltration of soft tissue with a honeycomb pattern and the thickening of dermis indicating a chronic lymphoedema.

A glomus tumour is a mesenchymal neoplasm composed of cells resembling the perivascular modified smooth muscle cells of the normal glomus body [ 57 ].

Glomus tumours also have a nerve component. Malignant glomus tumours are very uncommon [ 57 ]. Glomus tumours particularly affect women [ 75 , 76 ].

The average size is 5—6 mm and rarely exceeds 1 cm. Distal lesions of the nail bed are visible as a reddish-blue spot if the lesion is large enough. The typical clinical triad of localised tenderness, severe pain, and cold sensitivity is highly suggestive of a glomus tumour.

More proximal sub-matrix lesions are hidden under the posterior skin fold but may result in longitudinal cracking of the nail bed if there is matrix compression [ 77 ]. MRI is indicated either as a first-line imaging technique, in particular in the case of painful postoperative recurrence, or after a non-contributory ultrasound examination [ 6 , 63 ].

MRI can detect lesions as small as 1. This examination usually shows a limited nodule, generally homogeneous, hypointense on T1-weighted images and hyperintense on T2-weighted images, hypervascular with a very intense enhancement on MRA, or contrast-enhanced T1-weighted fat-suppressed sequence Fig.

An erosion of the dorsal surface of the phalanx may be present with larger tumours. Dynamic CTA with bone subtraction also seems to be an efficient tool for the diagnosis of glomus tumours Fig.

Glomus tumour of the third finger in a year-old woman. a , b Axial T2-weighted MR images and contrast-enhanced T1-weighted fat-suppressed sequence showing a small hypervascularised nodule arrow of the ulnar side of the nail matrix.

Glomus tumour of the thumb in a year-old man. Dynamic CTA with bone subtraction showing a small hypervascularised tumour arrow of the nail bed. Angioleiomyoma is a rare benign vascular smooth muscle tumour arising from the tunica media of vessel walls.

Angioleiomyoma affects a wide age range, peaking in the fourth through sixth decades of life. Approximately half of angioleiomyomas are painful. Imaging techniques show a small less than 3 cm long , well-circumscribed oblong tumour in the subcutaneous fat layer and dermis. The MR pattern is nonspecific with variable enhancement on contrast-enhanced T1-weighted fat-suppressed sequence.

Myopericytoma is a rare and distinctive perivascular tumour generally arising in the dermis and subcutis in the distal extremities. Myopericytomas are mostly seen in adults. These tumours are painless. MRI shows a small less than 2 cm , nodular, well-circumscribed subcutaneous tumour with a strong enhancement on contrast-enhanced T1-weighted fat-suppressed sequence.

Myopericytomas are usually connected to a vessel and may develop within the lumen of a vessel. Vascular lesions of the hand have various origins.

US may be the initial imaging modality, but CTA or MRA is also required, providing detailed vascular mapping, functional information, and precise determination of the extent of the lesions.

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J Ultrasound Med 38 5 — Yoo HJ, Choi JA, Chung JH et al Angioleiomyoma in soft tissue of extremities: MRI findings. AJR Am J Roentgenol 6 :W—W Download references. MRA scans can be performed with a contrast material or without.

If required, the technologist administers the contrast material in a vein of your arm through a small intravenous IV catheter. Inside the machine, the radio waves and magnetic fields surround your body, creating images. While the scanner is running, patients can expect a great amount of noise.

Because of this, all patients are required to wear hearing protection or headphones with music. The technologist will communicate through an intercom system keeping the patient informed about length of each sequence.

The patient is also given a call button in case of an emergency. Before your test, the doctor will most likely give you instructions, such as not eating or drinking for four to six hours. You might not be able to have an MRA done if you have a metallic device, such as an artificial heart valve or pacemaker, are pregnant or weigh more than pounds.

Most pose no risk, but you should inform the technologist, or your doctor may give you a card to present to the technologist that has information about your implant. MRAs and MRIs are similar tests. The primary difference is the application of the technology.

The primary difference between the two procedures is an MRA is specifically used for examining blood vessels. Without making any incisions, the doctor can see the many complex and tiny blood pathways through your body.

They may use the contrast material to highlight your vessels and potential blockages. The doctor will likely recommend an MRA test if you or a loved one suffers from a stroke, blood clot, heart disease or a similar health condition.

The MRI helps the doctor examine areas of your body like your chest, abdomen, internal organs and pelvis. Also, MRIs tend to have a bigger area for the doctor to examine instead of simply a single vessel or vein.

The MRI is the most commonly used imaging test of the spinal cord and brain. Doctors often use it to help them diagnose:.

The functional MRI fMRI of the brain is a particular type of MRI. It might help in examining the anatomy of the brain and determine which brain parts are handling essential functions. This can help the doctor identify essential movement and language control areas of the brain in individuals considered for brain surgery.

The doctor might use an MRI to check for abnormalities like tumors of many body organs such as the kidneys, pancreas, spleen, ovaries or liver. Repetitive or traumatic injuries such as torn ligaments or damaged cartilage can cause joint abnormalities.

Bone infections can be a sign of a tumor. Soft tissue and bone tumors are rare. Tumors are either malignant or benign. Malignant tumors are likely cancerous and may spread to other body parts, particularly the lungs and other bones.

Doctors might use MRIs combined with mammography for detecting breast cancer, especially in women with dense breast tissue or those with a higher risk of the disease.

When in need of an MRI or MRA, schedule an appointment at Health Images. As a premier medical imaging destination, we offer same-day appointments, board-certified radiologists and a professional, compassionate and skilled staff.

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Stroke vascular distributions – Imaging Case Review