Multimodality Image-Guided Sclerotherapy of Low-Flow Orbital Vascular Malformations: Report of Single-Center Experience

Samer Harmoush, Ponraj Chinnadurai, Kamel El Salek, Zeyad Metwalli, Honey Herce, Amit Bhatt, Paul Steinkuller, Timothy Vece, Shakeel Siddiqui, Ashwin Pimpalwar, Douglas Marx, Michel Mawad, Sheena Pimpalwar

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Purpose To evaluate the role of multimodality imaging tools for intraprocedural guidance and outcome evaluation during sclerotherapy of low-flow orbital vascular malformations. Materials and Methods A retrospective review was performed of 17 consecutive patients with low-flow orbital malformations (14 lymphatic, two venous, and one venolymphatic) who underwent multimodality image-guided sclerotherapy between November 2012 and May 2015. Sclerotherapy technique, image guidance tools, and complications were recorded. Sclerotherapy outcome was evaluated using clinical response, magnetic resonance (MR) image-based lesion volumetry, and proptosis quantification. Results There were 22 sclerotherapy sessions performed. Intraprocedural ultrasound (US), fluoroscopy, cone-beam computed tomography (CT) and MR image fusion were used for image guidance with 100% technical success. Resolution of presenting symptoms was observed in all patients at 1-month follow-up. Four major sclerotherapy complications were successfully managed. Statistically significant reduction in lesion volume (P =.001) and proptosis (P =.0117) by MR image analysis was achieved in all patients in whom 3-month follow-up MR imaging was available (n = 13/17). There was no lesion recurrence at a median follow-up of 18 months (range, 8-38 mo). Conclusions Multimodality imaging tools, including US, fluoroscopy, cone-beam CT, and MR fusion, during sclerotherapy of low-flow orbital malformations provide intraprocedural guidance and quantitative image-based evaluation of treatment outcome.

Original languageEnglish (US)
Pages (from-to)987-995.e4
JournalJournal of Vascular and Interventional Radiology
Issue number7
StatePublished - Jul 1 2016


  • Abbreviations DAP dose area product
  • IOP intraocular pressure
  • STS sodium tetradecyl sulfate

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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