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Reprinted by permission of Clin Radiol. 2014; 69(5):443-457.

Clinical Radiology 69 (2014) 443 e 457

Contents lists available at ScienceDirect

Clinical Radiology

journal homepage: www.clinicalradiologyonline.net

Review S.E. Mitchell Vascular Anomalies Flow Chart (SEMVAFC): A visual pathway combining clinical and imaging fi ndings for classi fi cation of soft-tissue vascular anomalies q A. Tekes a , * , J. Koshy b , T.O. Kalayci b , K. Puttgen c , B. Cohen c , R. Redett d , S.E. Mitchell e a Section of Pediatric Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Sciences, USA b Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Sciences, USA c Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA d Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA e Division of Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Sciences, USA

article information

Classi fi cation of vascular anomalies (VAs) is challenging due to overlapping clinical symptoms, confusing terminology in the literature and unfamiliarity with this complex entity. It is important to recognize that VAs include two distinct entities, vascular tumours (VTs) and vascular malformations (VaMs). In this article, we describe SE Mitchell Vascular Anomalies Flow Chart (SEMVAFC), which arises from a multidisciplinary approach that incorporates clinical symptoms, physical examination and magnetic resonance imaging (MRI) fi ndings to establish International Society for the Study of Vascular Anomalies (ISSVA)-based classi fi cation of the VAs. SEMVAFC provides a clear visual pathway for physicians to accurately diagnose Vas, which is important as treatment, management, and prognosis differ between VTs and VaMs. 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Article history: Received 3 September 2013 Received in revised form 12 November 2013 Accepted 25 November 2013

Introduction

imaging fi ndings, rarity of the VAs, lack of physician expe- rience, and multidisciplinary approach in many centres contribute to the chaos in diagnosis and management of VAs. To clarify this situation, correct terminology for each entity should be consistently used amongst all disciplines involved in the care of VAs. Even as recently as 2009, Has- sanein et al. found that the term “ haemangioma ” was used incorrectly in 71.3% of publications that year. 1 This empha- sizes the importance of understanding the current classi fi - cation system that was approved by International Society for the Study of Vascular Anomalies (ISSVA) in 1996 ( Table 1 ), which stems from the biological behaviour-based classi fi cation system introduced by Drs Mulliken and

The classi fi cation of vascular anomalies (VAs) is confusing to most physicians. Overlapping clinical and

q Disclaimer: This article is modi fi ed from a book chapter: Tekes A, Kalayci TO, Mitchell SE. Congenital vascular anomalies: classi fi cation and terminology. In Mauro MA, Murphy KP, Thomson KR, et al. (editors) Image-Guided Interventions , 2 edn. Philadelphia: Saunders, 2013; pp. 271 e 283. * Guarantor and correspondent: A. Tekes, Division of Pediatric Radiology, Section of Pediatric Neuroradiology, Johns Hopkins University School of Medicine, Zayed Tower Rm 4174, 1800 Orleans Street, Baltimore, MD 21287- 0842, USA. Tel.: þ 1 410 614 3772; fax: þ 1 410 502 3633. E-mail address: atekes1@jhmi.edu (A. Tekes).

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