Prediction of venous malformations with localized intravascular coagulopathy with diffusion-weighted magnetic resonance imaging

Abstract

Background

Venous malformations may be complicated by localized intravascular coagulopathy which is a serious condition with hematological sequel. Prediction of localized intravascular coagulopathy is mandatory for prompt anticoagulation therapy. Laboratory and routine magnetic resonance imaging can predict localized intravascular coagulopathy in venous malformations; however, the results are variable.

Purpose

To predict venous malformations with localized intravascular coagulopathy with diffusion-weighted magnetic resonance imaging.

Material and methods

A retrospective analysis was performed on 55 patients (34 male, 21 female aged 14–64 years: mean 39 years) with venous malformations that underwent diffusion-weighted magnetic resonance imaging. The apparent diffusion coefficient value of venous malformations was calculated.

Results

The mean apparent diffusion coefficient value of venous malformations with localized intravascular coagulopathy (n = 26) (1.28 ± 0.18 × 10⁻³mm²/s) was significantly different (P = 0.001) from venous malformations without localized intravascular coagulopathy (n = 29) (1.60 ± 0.18 × 10⁻³mm²/s). When apparent diffusion coefficient value of 1.454 × 10⁻³mm²/s was used as a threshold value for the prediction of venous malformations with localized intravascular coagulopathy, the best result was obtained with an accuracy of 83.6%, sensitivity of 84.6%, specificity of 82.8%, and area under the curve of 0.895. The apparent diffusion coefficient value of venous malformations was correlated with D-dimer level (r = −0.59, P = 0.006) and fibrinogen level (r = 0.73, P = 0.001).

Conclusion

The apparent diffusion coefficient value is a non-invasive imaging parameter that can be used to predict venous malformations with localized intravascular coagulopathy.