What can 3D CT angiography add in evaluation of facial vascular lesions?

To demonstrate the value of 3D CT angiography (CTA) in the evaluation of facial vascular lesions regarding diagnosis, characterization and full extensions compared to conventional 2D CTA. This prospective study included 16 patients with facial vascular lesions with ages that range from 1 to 45 years and mean age of 23 years, patients performed CT angiography (2D and 3D) utilizing the coronal and sagittal MPR and VR techniques. Lesions were evaluated by both 2D and 3D sequences regarding characterization and complete extension including intracranial extension. Our results were correlated with maxillofacial and plastic surgery results. Among the 16 patients, 7 had hemangiomas, 5 had AVMs and 4 had AVFs. In hemangiomas, 2D successfully evaluated (regarding diagnosis, characterization and full extensions) 5 patients (71.5%) and 2 patients were in doubt regarding diagnosis, while 3D CTA successfully evaluated all the patients (100%). In AVMs, 2D CTA successfully evaluated 4 patients (80%), one patient was in doubt regarding intracranial extension, while 3D CTA successfully evaluated all the patients (100%). In AVFs, 2D and 3D CTA successfully evaluated all the patients (100%). For all cases, diagnostic accuracy of 2D CTA was 81.3%, while diagnostic accuracy of 3D CTA was 100%. CTA offered noninvasive excellent angiographic imaging modality of the facial vascular lesions. The 3D CTA in particular (with high spatial and temporal resolution) provided distinct features that enabled excellent lesion detection, characterization, visualization of feeding arteries and draining veins and complete extensions. The 3D CTA allowed accurate differentiation of hemangiomas from AVMs that is sometimes difficult using clinical examination and 2D CTA. The 3D CTA plays an important role in extension evaluation, treatment planning (through full orientation of vascular tree) and follow up, thus eliminates the need for invasive DSA.