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Review
S.E. Mitchell Vascular Anomalies Flow Chart
(SEMVAFC): A visual pathway combining clinical
and imaging findings for classi fication of
soft-tissue vascular anomaliesq
A. Tekes a, *, J. Koshy b, T.O. Kalayci b , K. Puttgen c, B. Cohen c, R. Redett d,
S.E. Mitchell e
a Section of Pediatric Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Sciences, USA
b Division of Pediatric Radiology, The Russell H. Morgan Department of Radiology and Radiological Sciences, USA
c Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
d Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
e Division of Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Sciences, USA
article information
Article history:
Received 3 September 2013
Received in revised form
12 November 2013
Accepted 25 November 2013
Classification of vascular anomalies (VAs) is challenging due to overlapping clinical symptoms,
confusing terminology in the literature and unfamiliarity with this complex entity. It is
important to recognize that VAs include two distinct entities, vascular tumours (VTs) and
vascular malformations (VaMs). In this article, we describe SE Mitchell Vascular Anomalies
Flow Chart (SEMVAFC), which arises from a multidisciplinary approach that incorporates
clinical symptoms, physical examination and magnetic resonance imaging (MRI) findings to
establish International Society for the Study of Vascular Anomalies (ISSVA)-based classi fication
of the VAs. SEMVAFC provides a clear visual pathway for physicians to accurately diagnose Vas,
which is important as treatment, management, and prognosis differ between VTs and VaMs.
2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Introduction
The classification of vascular anomalies (VAs) is
confusing to most physicians. Overlapping clinical and
imaging findings, rarity of the VAs, lack of physician expe-
rience, and multidisciplinary approach in many centres
contribute to the chaos in diagnosis and management of
VAs. To clarify this situation, correct terminology for each
entity should be consistently used amongst all disciplines
involved in the care of VAs. Even as recently as 2009, Has-
sanein et al. found that the term “haemangioma” was used
incorrectly in 71.3% of publications that year.1 This empha-
sizes the importance of understanding the current classifi-
cation system that was approved by International Society
for the Study of Vascular Anomalies (ISSVA) in 1996
(Table 1), which stems from the biological behaviour-based
classification system introduced by Drs Mulliken and
q Disclaimer: This article is modified from a book chapter: Tekes A, Kalayci TO,
Mitchell SE. Congenital vascular anomalies: classification and terminology. In
Mauro MA, Murphy KP, Thomson KR, et al. (editors) Image-Guided Interventions, 2
edn. Philadelphia: Saunders, 2013; pp. 271e283.
* Guarantor and correspondent: A. Tekes, Division of Pediatric Radiology,
Section of Pediatric Neuroradiology, Johns Hopkins University School of
Medicine, Zayed Tower Rm 4174, 1800 Orleans Street, Baltimore, MD 21287-
0842, USA. Tel.: þ1 410 614 3772; fax: þ1 410 502 3633.
E-mail address: (A. Tekes).
Contents lists available at
Clinical Radiology
journal homepage:
0009-9260/$ e see front matter 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Reprinted by permission of Clin Radiol. 2014; 69(5):443-457.
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