Physiological interpretations of radiographic findings on malformations of small veins: seriality of cisterns, communications to systemic veins and relationship to muscles

OBJECTIVES To re-evaluate the fluoroscopic findings of venous malformation by cine mode cisternography. METHODS Using direct injection cine-cisternography, we studied 49 venous malformation lesions in the head and neck of 30 patients who were scheduled to undergo ethanol sclerotherapy. The diameter of definitively measurable 46 lesions was 21.7 ± 10.5 mm (mean ± SD, range: 6.0-48.0 mm). The injection was continued until the draining veins were clearly observed. Outflow communications between cisterns and systemic veins were classified into Type 1, no visible drainage; Type 2, draining into a normal venous system; and Type 3, with abnormally ectatic draining veins. The topological relationships of the lesions to surrounding structures were addressed using computed tomography, magnetic resonance imaging or ultrasonogram. Treatment results were evaluated. RESULTS The direct injection cine-cisternography showed the typical 'bunch of grapes' pattern, and revealed serial cisternal, followed by the appearance of outflow/draining veins in all lesions. There were no Type 1, 47 Type 2 and two Type 2 outflow pattern. Satellite lesions emerged via the communicating veins in six lesions. Of the all 49 lesions, 48 were located in or on the muscle fascia. Sclerotherapy was safely completed in all Type 2 lesions with satisfactory results, but for the Type 3 lesions treatment was limited to be partial to avoid complications. CONCLUSIONS The present study suggested that communications from venous malformation to the systemic vein are fluoroscopically confirmable. These radiographic findings were thought explainable in relation to developmental nature or facilitating process of venous malformation.