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B. L. Bohnsack, R. I. Cho, A. Sanchez-Castellanos, H. Parmar, J. J. Gemmete, C. C. Nelson, A. Kahana; Non-Invasive Contrast-Enhanced Magnetic Resonance Angiography is a Useful Tool in the Diagnosis and Treatment of Orbital Vascular Lesions. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5742.
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Vascular lesions of the orbit represent both diagnostic and therapeutic challenges. High-flow, low-flow and no-flow vascular anomalies require different approaches and treatment modalities. Digital subtraction angiography is invasive, and we have begun to use time-resolved dynamic contrast enhanced magnetic resonance angiography (CEMRA) in the evaluation and treatment of orbital vascular malformations. Here we review our findings on the usefulness of this new non-invasive imaging modality.
Retrospective chart review of patients with orbital vascular lesions who underwent CEMRA in order to determine the vascular characteristics of the mass and plan for surgical intervention.
8 patients with orbital vascular lesions were assessed with CEMRA. In patients with arteriovenous malformation (AVM), CEMRA was used to aid with diagnosis and identification of potential access routes prior to invasive angiography, as well as for post-embolization assessment to aid in surgical planning. In patients with mixed venous malformations, CEMRA was useful in making the diagnosis, as well as for assessing draining channels and identifying potential access routes (figure). In patients with pure lymphangiomas, CEMRA non-invasively revealed lack of major outflow channels, allowing for the use of an intraoperative sclerosing agent to aid in surgical debulking.
We demonstrate that CEMRA can be utilized as a non-invasive imaging tool to aid in the diagnosis of orbital vascular tumors. Its greatest utility may be in the perioperative-planning phase, where it can be used prior to invasive angiography to determine access routes, post-angiography to assess the success of embolization, and preoperatively to identify residual vascular flow and plan the surgical intervention.
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