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Publications

Journal Article Ahead of print

PubMed: 42034595 DOI: 10.1016/j.ejrad.2026.112883

Volumetric perfusion fraction change in MR angiography for monitoring sclerotherapy-related changes in peripheral venous malformations.

Eur J Radiol 200:112883

Authors: Fabian Haupt, Aleksandra Tuleja, Sarah M Bernhard, Bernd Jung, Jochen K Rössler, Laurence Boon, Miikka Vikkula, Yvonne Döring, Iris Baumgartner, Adrian T Huber, Hendrik von Tengg-Kobligk

Affiliations

  • Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, SITEM-Insel, Bern, Switzerland.
  • Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland; Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland.
  • Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland; Vascular Center, Bienna Hospital Center, Bienna, Switzerland.
  • Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, SITEM-Insel, Bern, Switzerland.
  • Division of Pediatric Hematology/Oncology, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Saint Luc University Hospital, Avenue Hippocrate 10, 1200 Brussels, Belgium.
  • Center for Vascular Anomalies, Division of Plastic Surgery, VASCERN VASCA European Reference Centre, Saint Luc University Hospital, Avenue Hippocrate 10, 1200 Brussels, Belgium; Human Molecular Genetics, de Duve Institute, University of Louvain, Avenue Hippocrate 74, 1200 Brussels, Belgium.
  • Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland; Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich (LMU), Munich, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany.
  • Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
  • Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

Abstract

BACKGROUND

In venous malformations (VMs), postprocedural edema on T2-weighted (T2w) MRI can obscure true post-treatment changes, making reliable posttherapeutic imaging-based monitoring challenging. Current MRI evaluation is often qualitative and center-dependent, underscoring the need for standardized quantitative parameters.

METHODS

We retrospectively analyzed patients with VMs treated at our hospital between 2018 and 2022 who underwent MRI with MR angiography (MRA) before and after ethanol sclerotherapy. VM volume was calculated from diameters measured in two orthogonal planes on T2w and MRA images. A new parameter, volumetric perfusion fraction (VPF), was calculated as the ratio of perfused MRA volume to total T2w volume. Parameters were compared using comparative tests and receiver operating characteristic (ROC) analysis reflecting each parameter's ability to distinguish baseline from post-sclerotherapy images.

RESULTS

Thirty-six patients with VMs were included (median age 21 years; 7 - 59 years; 24 female; 66.7 %). Total malformation volume on T2w images decreased by 9.0 % (45.4 mL; 0.6 - 801.9 mL vs 30.9 mL; 0.1 - 802.4 mL; p = 0.056) after therapy, whereas perfused MRA volume decreased by 87.4 % (26.1 mL; 0.5 - 643.6 mL vs 4.5 mL; 0.0 - 352.4 mL; p < 0.001). VPF decreased by 68.1 % (74.0 %; 10.1 - 131.7 % vs 18.2 %; 0.0 - 85.3 %; p < 0.001) despite considerable interindividual variability. ROC analysis showed the strongest effect for VPF, with an area under the curve (AUC) of 0.91 (p < 0.001), followed by MRA-derived diameter and volume (AUC 0.75 and 0.79; both p < 0.001). T2w MRI parameters showed the lowest effect (AUC 0.57; p = 0.30).

CONCLUSION

VPF showed the strongest discrimination of treatment effects compared with MRA and T2w measures. It may serve as a robust and objective MRI parameter for monitoring therapy-related changes in clinical routine and future trials.

MeSH

Sclerotherapy, Angiography, Radiology, Therapeutics