Diagnosis and Management of Infantile Hemangioma

Grey Literature
In response to 21 requests for Scientific Information Packets, we received four documents,
all of which addressed medications (becaplermin gel, recombinant interferon alfa-2b) that were
not evaluated in studies meeting our criteria. The documents yielded no citations of relevance for
this review, and the documents themselves did not meet criteria for inclusion in the review (one
case series of 8 individuals, one addendum to an article, two files of prescribing information).
Our search of ClinicalTrials.gov did not yield any results not identified in our other searches,
and our searches of the web sites of relevant organizations yielded background information for
informing our contextual questions.
Key Question 1. Effectiveness and Harms of Imaging
Modalities
Key Points
• Strength of the evidence (SOE) for the effectiveness of imaging for IH was insufficient
given few studies assessing varied outcomes.
• Studies assessed IH in different anatomic locations and reported differing findings for the
sensitivity of ultrasound and effectiveness of imaging modalities depending on location
or subtype.
Overview of the Literature
Two poor quality diagnostic accuracy studies—one prospective 68 and one retrospective 70 —
addressed imaging modalities. Both studies were conducted in tertiary care settings with care
settings in the United States, Canada, and Spain. One study enrolled patients from nine centers
and included patients less than18 years old with IH in the lumbosacral area measuring greater
than 2.5 cm. 68 The retrospective cohort study reported chart review data from two tertiary care
centers and included 55 patients (mean age of 30 days) with liver IH. 70
Overall, studies were limited by the size of cohorts, lack of standard processes, and lack of
direct comparison at the same time point using the various imaging modalities. We considered
the SOE for all imaging modalities to be insufficient given single, small studies addressing
different approaches, using weaker study designs and precluding a meta-analysis. The studies did
not address harms.
Detailed Analysis
In one prospective cohort study, seven out of 26 (26.9%) children who underwent ultrasound
had an abnormality compared with 21 of the 41 (51.2%) patients who received MRI and were
noted to have a spinal abnormality. 68 Nineteen of these patients underwent both ultrasound and
MRI. In five cases ultrasound did not reveal an abnormality later found on MRI. Agreement
between ultrasound and MRI was 0.27 (95% CI: -0.15 to 0.7, p=0.21), which was consistent with
chance. Ultrasound had a sensitivity of 50 percent (95% CI: 18.7% to 81.3%) and specificity of
77.8 percent (95% CI: 40% to 97.2%) for identifying anomalies including tethered cords and
intraspinal IH. We calculated the sensitivity of both modalities for identifying intraspinal IH
specifically: assuming a false positive value of 0, ultrasound, which missed 4 intraspinal IH in 26
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