4. TIW – LOBULATED LESION WITH INTERMEDIATE SIGNAL SAGITTAL IMAGE – LESION IS VENTRAL TO FLEXOR DIGITORUM LONGUS WITH A HYPOINTENSE NIDUS IN THE CRANIAL PART STIR – HYPERINTENSE LESION
6. POSSIBILITY OF AVM IS KEPT HIGH FLOW ON DOPPLER PALPABLE SWELLING NO PHLEBOLITH ON SOFT TISSUE RADIOGRAPH IMMEDIATE POST CONTRAST ENHANCEMENT NIDUS APPRECIATED DIFFUSE RELATIVELY DELAYED ENHANCEMENT DRAINING VEINS APPRECIATED IN RELATION TO THE LESION
7. DISCUSSION- DSA VERSUS MR ANGIO. DSA Preferred method for detection of vascular pathology Invasive Iodinated contrast agents Radiation May fail to demonstrate significant extraluminal disease. MR ANGIO – WITH/WITTOUT CONTRAST Flow related enhancement –TOF Contrast – shortens t1 relaxation time. Parallel imaging Keyhole imaging Challenge – timing of the contrast – bolus tracker .
8. DIFFERENTIALS GLOMUS TUMOR Nail bed / Finger tips. Common in hands Recurrence Pinpoint pain / Paroxysmal pain/Cold hypersistivity. Pain full Subcutaneous nodule in subungal position. Hyperintense on t2w High blood flow on doppler HAEMANGIOMA At birth – 30 % 4th wk – 70% 10- 14 years – maximum involute ( fibrofatty change) Calcification on plain Radiographs .
11. The deep palmar arch is supplied by the radial artery as it passes under the “snuff box” tendons and gives rise to the princepspollicis and deep palmar arch.
13. CONGENITAL AND DEVELOPMENTAL VASCULAR ANOMALIESY ARTERIOVASCULAR MALFORMATIONS PROLIFERATIVE VASCULAR LESIONS LOOK FOR MAJOR COMPONENT – ARTERIAL / VENOUS / CAPILLARY / LYMPHATIC AND DEFINE ACCORDINGLY. NOT TRUE MITOTIC LESIONS ARTERIAL LESIONS ARE – HIGH FLOW VENOUS LESIONS – PHLEBOLITHS,DIFFUSE ENHANCEMENT, SEPTATIONS , LOBULATIONS. LYMPHATIC – SEPTAL ENHANCEMENT , LOBULATION . CAPILLARY – TOUGH TO DEFINE ON MR FOR THERE SUPERFICIAL LOCATIONS. AVM – LOOK FOR NIDUS - EARLY ARTERIAL ENHANCEMENT – EARLY FILLING OF VEINS – TOURTUOS FEEDING ARTERIES - TORTUOS DRAINING VEINS –SECONDARY EFFECTS ON ORGANS Infantile/ congenital haemangioma’s True Mitotic lesion May or may not involute Mass lesion with hyperintense signal on t2w sequence with homogenous enhancement.
14. While diagnosing vascular lesions SOME OF THE LESSONS LEARNT…………………………. Duration of pathology – congenital – infantile - acquired Examine the Radiograph : Phlebolith , calcification. Pain in the lesion- pinpointing ,paroxysmal – glomus tumor Subungalsubcutaeoussmall lesion – glomus tumor Tumor like look – proilferative vascular lesions High flow lesions – primarily arterial Nidus in the lesion – AV malformation Arterial component – Early enhancement Venous component – Diffuse ,Septal enhancement . PHLEBOLITHS Lymphatic component- Septal pattern of enhancement
![PRESENT CASE CLINICAL PROFILE : 45 yr female with Swelling Rt hand index finger . Previous history of intervention present . ? glomustumor. No record of histopathologicale examination. Previous history of appendicectomy and deroofing of Rt ovarian cyst. Present study done to assess relation of the swelling to the digital arteries. ,[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)