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fl
ow void within the IH noted in T2-weighted imaging
represents the arterial feeder, an important diagnostic clue.
DCE-MRA demonstrates early arterial enhancement in a
soft-tissue mass with a draining vein. Typically, no perile-
sional oedema is observed, which helps differentiation from
other soft-tissue malignancies. Fibro-fatty in
fi
ltration can
be observed during the involuting phase (
Fig 2
c
e
f).
Congenital haemangioma
Unlike IHs, CHs are fully formed at birth, with nearly no
growth after birth, and lack positive staining with GLUT-1.
Clinically, RICHs (
Figs 1
and
3
) and NICHs (
Figs 1
and
4
)
appear similar, often presenting as violaceous grey tumours
with prominent overlying veins or telangiectasias, which
extend beyond the periphery of the lesion. Many have a
lighter or bluish halo on the surrounding skin. In practice,
RICH and NICH are distinguished in retrospect, as the
former involutes by 12 months of age, and the latter in-
volutes either partially or not at all and requires surgical
excision. RICH, too, can leave signi
fi
cant textural change
necessitating reconstructive surgery after involution.
20
Early and accurate diagnosis is critical to avoid unnec-
essary biopsy/surgical intervention.
21
Similar histological
and clinical features of RICH and NICH raise the possibility
that the latter may undergo involutional arrest to become a
non-involuting tumour.
22
Kaposiform haemangioendothelioma
KHE is a rare distinct vascular tumour,
23
which may
present at birth or within the
fi
rst few months of life as an
Figure 3
(a) Newborn with a round purple mass on the right thigh. Note that the skin has coarse telangiectasia, and that there is a peripheral
pallor typical for CHs. (b) Same patient at 5 months of age. Note that the lesion has spontaneously involuted very rapidly, con
fi
rming that this is a
RICH.
Figure 4
(a) A 4-year-old male patient with a raised, round lesion on the right shin since birth without regression. Note the coarse purple
telangiectasia on the skin. (b) Axial T1-weighted image without fat saturation clearly demonstrates the in
fi
ltration of the skin, typical for CHs. (c)
Axial contrast-enhanced T1-weighted image with fat saturation demonstrates avidly enhancing solid vascular mass with skin in
fi
ltration.
Constellation of imaging
fi
ndings with patient
’
s age and no regression since presentation at birth makes the diagnosis of a NICH.
A. Tekes et al. / Clinical Radiology 69 (2014) 443
e
457
248