MR Features of Juxta-Articular Venous Malformations of the Knee to Predict the Clinical Outcome of Sclerotherapy |
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| Affiliation: | 1. Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland;2. Department of Diagnostic Imaging, University Children’s Hospital Zurich, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland;3. Division of Plastic and Reconstructive Surgery and Department of Surgery, University Children’s Hospital Zurich, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland;4. Departments of Orthopaedics and Surgery, University Children’s Hospital Zurich, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland;5. Division of Pediatric Dermatology, University Children’s Hospital Zurich, Steinwiesstrasse 75, CH 8032 Zurich, Switzerland;6. Department of Orthopaedics, Der Balgrist–Universitätsklinik, Zurich, Switzerland;1. American Hip Institute, Westmont, Illinois, U.S.A.;2. Mayo Clinic Arizona, Phoenix, Arizona, U.S.A.;3. Hinsdale Orthopaedics, Hinsdale, Illinois, U.S.A.;4. Department of Orthopaedics, Hadassah Hebrew University Hospital, Jerusalem, Israel;1. Departments of Urology, University Medical Center Goettingen, Goettingen, Germany;2. Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany;3. Section of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510;4. Section of Medical Oncology, Department of Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510;5. Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510;1. Service de radiologie B, AP–HP, centre hospitalier universitaire Cochin, faculté de médecine, université Paris Descartes, 75679 Paris, France;2. Service de médecine physique and de réadaptation, AP–HP, centre hospitalier universitaire Cochin, faculté de médecine, université Paris Descartes, 75679 Paris, France;3. Inserm, U1153 Epidemiology and Biostatistics Sorbonne Paris Cité Center (CRESS), épidémiologie clinique appliquées aux maladies ostéo-articulaires (Ecamo), université Paris Descartes, 75679 Paris, France;1. Vascular Anomalies & Malformations Program (VAMP) at the Division of Vascular Surgery, Department of Surgery, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, Bristol-Myers Squibb Children''s Hospital, New Brunswick, NJ;2. Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ;3. Director for the Center for Wound Healing at Robert Wood Johnson University Hospital, New Brunswick, NJ;4. Division of Vascular Surgery, Department of Surgery, The Center for Wound Healing, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, New Brunswick, NJ |
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| Abstract: | PurposeTo analyze and correlate preinterventional magnetic resonance (MR) imaging findings with clinical symptoms after percutaneous sclerotherapy of venous malformations (VMs) adjacent to the knee.Materials and MethodsTwenty-five patients (mean age, 24 y; range, 7–55 y; 11 female) with 26 VMs adjacent to the knee undergoing sclerotherapy (direct puncture, diagnostic angiography, sclerosant injection) were identified, and MR imaging findings were analyzed. The VM involved the synovium of the knee joint in 19 of 26 cases (76%). These lesions were associated with joint effusion (3 of 19; 16%), hemarthrosis (4 of 19; 21%), or synovial thickening (16 of 19; 84%). Follow-up ended 6–8 weeks after the first or second sclerotherapy session if complete pain relief was achieved or 3 months after the third sclerotherapy session. Treatment outcomes were categorized as symptom improvement (complete or partial pain relief) or poor response (unchanged or increased pain).ResultsForty-nine percutaneous sclerotherapy sessions were performed. Despite the absence of signs of knee osteoarthritis, patients with a VM involving the synovium (8 of 14; 57%) showed a poor response to sclerotherapy (1 of 8 [13%] pain-free after 1 sclerotherapy session). Among patients with VMs with no associated joint alteration and no synovial involvement (6 of 14; 43%), 5 of 6 (83%) showed improvement of symptoms after 1 sclerotherapy session (P < .05).ConclusionsJuxta-articular VMs of the knee are frequently associated with hemarthrosis and synovial thickening. Patients with signs of osteoarthritis and synovial involvement of the VM on presclerotherapy MR imaging deserve special consideration, as these findings predict worse clinical symptoms after sclerotherapy. |
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