Tests
1st tests to order
Tests to consider
MRI (without and with IV contrast) of hemangioma
Test
Indicated when clinical exam and ultrasound fail to provide a diagnosis, or when the extent of the lesion and relationship to adjacent structures needs to be defined more fully.[24][25] MRI with contrast may differentiate infantile hemangioma from venous, arteriovenous, and lymphatic malformations.[26] MRI can also be used to distinguish an infantile hemangioma from an encephalocele or meningocele/myelomeningocele.[10] MRI studies are a useful adjunct to distinguish infantile hemangioma from malignant soft-tissue masses, including fibrosarcoma. Diagnostic specificity is reported to be up to 90%, with negative predictive value for malignancy up to 94%.[27] MRI is also the test of choice to evaluate associated anomalies of the spine, brain, etc., when considering syndromic infantile hemangioma.[14]
Result
hyperintense T2-weighted images, hypointense T1-weighted images, enhancement with contrast, lobulation, septation, central low-intensity dots
biopsy of lesion
Test
If a malignant tumor with a significant vascular component is considered a possibility, biopsy with histopathologic exam and special tissue stains, including GLUT1, is indicated.[28] GLUT1 is an erythrocyte-type glucose transporter present in infantile hemangioma, brain, and placenta.[29][30][31]
Result
variable findings distinguish proliferative (lobular, cellular, slit-like vascular lumina, normal mitoses, stromal mast cells) from involuting (enlarged vascular lumina, fewer vessels, fibro-fatty tissue)
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