Case Study | EXTREMITY IMAGING
Specialty MR in Pediatrics
Hand Hemangioma Evaluation
Hemangiomas of infancy are benign (non-cancerous) vascular tumors composed
of cells that normally line the blood vessels (endothelial cells). They are the most
common tumor of childhood, occurring in up to 10% of infants. Hemangiomas of
infancy may be visible at birth or may not be recognized until the first few weeks
or even months of life. In general, however, most hemangiomas become evident
by two to three weeks of age. Although they commonly occur on the head or neck
(60%), they can occur in any region of the body. Some lesions are small and hardly
visible, whereas others are large and readily observable. Most hemangiomas
appear as single tumors, though 15% present with more than one lesion.
While numerous imaging modalities can be used to investigate hemangiomas,
clinical experience has shown that ultrasonography, with Doppler interrogation,
and MR imaging are the two most effective modalities. The choice will be based
on the reason for studying the patient and available modalities in each institution.
If we can understand how a hemangioma forms, we should be able to accelerate
its disappearance, or prevent its growth in the first place.
A 12-year-old was referred for a soft-tissue MR follow up exam of a deep hemangioma
of the left hand. Patient has been seen in the pediatric clinic since 2008. These
hemangiomas appear bruise-like or bluish in color. They’re often not diagnosed
until swelling becomes apparent.
is a Consultant Radiologist
at Radiologische Institut
Dr. von ESSEN (Koblenz,
To best determine the nature of the lesion, the following MR sequences are
recommended: T1w, T1w with fat saturation, PD w with fat saturation or Inversion
Recovery, and gradient flow sequence or MR angiogram. The field of view should
include not only the obvious lesion but tissues that could be involved by contiguity
with the hemangioma, or associated malformed states. In general, hemangiomas
are characterized by discrete margins, and relatively homogenous signal intensity
and enhancement. Hemangiomas appear as well-circumscribed masses that have
a lobular architecture with intense and persistent tissue staining.