Efficacy of Magnetic Resonance Angiography in the Evaluation of Vascular Malformations of the Hand

Conventional arteriography has been the accepted standard technique for demonstrating the anatomic details in vascular malformations of the hand. The technique of magnetic resonance angiography provides detailed anatomy for vascular anomalies of the hand without the use of an invasive technique or contrast enhancement. When magnetic resonance angiography is combined with magnetic resonance imaging, the extent of the lesion with respect to the surrounding tissues and the flow characteristics of the lesion can be determined noninvasively. In our institution, magnetic resonance angiography has replaced conventional arteriography as the technique of choice for the evaluation of these lesions. This report evaluates the efficacy of magnetic resonance imaging/ magnetic resonance angiography in the management of vascular malformations of the hand. Ten consecutive patients over 30 months (median age 37 years) underwent magnetic resonance imaging/magnetic resonance angiography evaluation after the clinical diagnosis of a vascular malformation of the hand was made. Four patients in the group had conventional arteriography performed before referral. Magnetic resonance imaging/magnetic resonance angiography clearly defined the anatomic extent of the lesion, its relationship to surrounding tissues, and the flow characteristics in each patient. In the four patients in whom conventional arteriography had been performed, the magnetic resonance angiography findings matched the arteriographic findings. On the basis of the magnetic resonance imaging/magnetic resonance angiography findings, six patients were treated nonoperatively with compressive garments and four patients had operative treatment (resection of lesion n = 2, digital ray resection n = 2). In this series, magnetic resonance imaging/magnetic resonance angiography was efficacious in the management of vascular malformations of the hand. This technique provides detailed images of both the arterial and venous components of the lesions without the requirements of contrast enhancement, ionizing radiation, or an invasive procedure. Furthermore, the resectability can be determined based on the extent of involvement and the flow characteristics.