The Value Of Three-Dimensional CT Angiography In The Diagnosis And Treatment Of Vascular Lesions

Objective: The accurate classification of vascular lesions is important because treatments and prognosis vary from type to type. Since it is difficult to make differential diagnoses for the lesions only relying on clinical features, diagnoses are often incorrect, which may, in turn, result in inappropriate treatment. Three-dimensional (3-D) computed tomography angiography (CTA) is a relatively new technique, which is able to provide an exquisite view of many lesions' architecture. Up to now, there have been reports on utility of 3-D CTA in differential diagnoses of vascular lesions, but, few studies on the clinical use, such as assisting treatment, of 3-D CTA in vascular lesions have been appeared in literature. This study was designed to evaluate the value of 3-D CTA in the diagnosis and treatment of vascular lesions.Methods: This study involved 26 patients with vascular lesions of soft tissue, who were treated in our department from May, 2006 to August, 2007. All the patients underwent 3-D CTA by duel source CT and therapeutic plans were made based on their 3-D CTA images. Operation was imposed on all patients and during the surgeries. We determined the accuracy rates of the picture 3-D CTA delineated, including the feeding vessels, size, extent, depth, tissues encroach as well as what involved in. We observed the recurrence condition in the sixth month follow-up. Pathological examinations were also done to testify our diagnoses after surgeries.Results: All the radiological diagnoses were proven by pathology. Eight of the patients suffered from venous malformation, and 3-D reformations showed a lacy tangle of vessels. The draining veins were enlarged and tortuosity. Eight of them suffered from arteriovenous malformation, and on 3-D reformations, the appearance was a tangle of disorganized vessels, tenser than those of venous malformations. Ten of them suffered from hemangioma, and 3-D reformations showed a mass with slightly or scarcely enlarged feeding vessels. The feeding vessels were in normal fashion and there were no tortuous appearance. The surface of the mass resembled the surface of a cauliflower. Lesions of vascular malformation were fully removed by operations, while, in hemangiomas, chemotherapy was used in order to minimize the lesions and simplified the following operations. All patients were cured without complications and recurrence. According to the operation records, the accuracy rates of the extent 3-D CTA delineated were 100%, the accuracy rates of the feeding vessels were above 80%, of the contents were above 75%, and of the involved structures were above 60%.There is no significant difference among hemangiomas, arteriovenous malformation, and venous malformations in the accuracy rate.Conclusion: Our study suggests that 3-D CTA is helpful in differential diagnosis of hemangiomas and vascular malformations, as well as providing a global overview of the lesions, and that 3-D CTA aids a lot in making therapeutic planning. This technique may be a common, convenient method for surgeons to diagnose and treat vascular lesions.