Multiparametric MRI Features that Predict Treatment Response to Endovascular Sclerotherapy in Craniofacial Venous Malformations

Abstract Purpose Craniofacial venous malformations (VMs) cause severe psychological and physiological burden to patients, and treatment is meaningful only when the benefits of treatment outweigh the risks. Therefore, it is very important to predict the treatment response before treatment. This study was performed to explore the value of multiparametric magnetic resonance imaging (MRI) for predicting treatment response to endovascular sclerotherapy in VMs. Materials and Methods We designed and implemented a case-control study and enrolled a sample from patients with VM treated by endovascular sclerotherapy at our hospital from January 2014 through January 2018. The primary predictor variables were pre-treatment volume (pre-volume), lesion classification, phleboliths, initial slope of increase (ISI) , gender, age and sclerosants. The primary outcome variable was treatment response ( positive response or negative response). Descriptive, univariate and multivariate binary logistic regression, and Firth`s penalized maximum likelihood estimate were computed to measure the association between predictor variables and treatment response. The level of statistical significance was set at a P value less than or equal to 0.05. Results The sample was composed of 42 patients with a median age of 17.50 years old and 33.3% were male. There were 27 and 15 patients in the positive and negative response groups, respectively. There were significant differences between the two groups for ISI (adjusted odds ratio (OR) =2.184; P=0.0268; 95% confidence interval (CI),1.094-4.360), lesion classification (adjusted OR=9.072; P=0.0226; 95% CI, 1.363-60.400) and pre-volume (adjusted OR=1.020; P=0.0268; 95% CI, 1.002-1.038). The cut-off point for pre-volume and ISI was 40.42 cm3 and 2.61. Conclusions Multiparametric MRI could provide an approach for predicting treatment response in craniofacial VMs. When the pre-volume was >40.42 cm3, ISI was >2.61, and the classification was infiltrating type, the response to sclerotherapy was negative.