{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T02:50:43Z","timestamp":1761274243222,"version":"build-2065373602"},"reference-count":24,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T00:00:00Z","timestamp":1761177600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82272288","82472577"],"award-info":[{"award-number":["82272288","82472577"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Shanghai Plastic Surgery Research Center of Shanghai Priority Research Center","award":["2023ZZ02023"],"award-info":[{"award-number":["2023ZZ02023"]}]},{"name":"Industry-commissioned research project from Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine","award":["JYHX2025007","JYHX2025014"],"award-info":[{"award-number":["JYHX2025007","JYHX2025014"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Venous malformations (VMs) that infiltrate the muscular layer, involve or are closely adjacent to critical nerves or vessels, or are located deep within or very close to major organs in the thoracic or abdominal cavities are challenging to access during sclerotherapy, which we defined as inaccessible VMs. This study proposed an integrated real-time stereotactic MRI-guided sclerotherapy with bleomycin-polidocanol foam (RSMS-BPF) for the treatment of inaccessible VMs, focusing on its clinical feasibility, efficacy, and safety. Methods: A retrospective study was conducted involving patients treated with RSMS-BPF between 2019 and 2021. During the sclerotherapy, the intraoperative magnetic resonance imaging (MRI) was combined with an optical navigation system to guide precise needle placement and track BPF, a foam sclerosant optimized for MRI visibility. Radiological response was assessed by lesion volume, while clinical improvement was evaluated through patients\u2019 description of their symptoms. Rigorous follow-up and documentation of complications were conducted. Results: A total of 42 patients (mean age 23.6 \u00b1 1.6 years; 18 males) were treated in 64 sclerotherapy sessions. The treatment achieved an overall response rate of 89.5%. Imaging analysis revealed an average lesion volume reduction of 59.6%. 57.9% of patients achieved good or excellent radiological responses. After a median follow-up of 12.25 months, 60.53% of patients reported complete or significant relief. Lesion depth did not affect treatment efficacy (p = 0.43). Minor complications included skin hyperpigmentation (5.3%, 2\/38) and blisters (2.6%, 1\/38), with no major complications observed. Conclusions: RSMS-BPF demonstrated satisfactory efficacy and safety in VMs treatment, particularly for inaccessible VM lesions. It enables authentic real-time dynamic tracking during sclerotherapy, achieving unparalleled precision targeting while minimizing procedural risks. These findings strongly support routine integration of RSMS-BPF as first-line therapy for complex vascular malformations with critical anatomical constraints.<\/jats:p>","DOI":"10.3390\/jcm14217509","type":"journal-article","created":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T02:34:45Z","timestamp":1761273285000},"page":"7509","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real-Time Stereotactic MRI-Guided Sclerotherapy with Bleomycin-Polidocanol Foam: Illuminating Inaccessible Venous Malformations"],"prefix":"10.3390","volume":"14","author":[{"given":"Xuan","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zimin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Radiology, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1324-0842","authenticated-orcid":false,"given":"Hongyuan","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingwei","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoxi","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China"},{"name":"Department of Laser and Aesthetic Medicine, Shanghai Ninth People\u2019s Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Huangpu District, Shanghai 200011, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"477","DOI":"10.3390\/dermatopathology8040050","article-title":"Venous Malformations in Childhood: Clinical, Histopathological and Genetics Update","volume":"8","author":"Colmenero","year":"2021","journal-title":"Dermatopathology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s42155-018-0009-1","article-title":"Image guided sclerotherapy for the treatment of venous malformations","volume":"1","author":"Gorman","year":"2018","journal-title":"CVIR Endovasc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1016\/j.bjps.2013.07.033","article-title":"Surgical treatment for venous malformation","volume":"66","author":"Steiner","year":"2013","journal-title":"J. Plast. Reconstr. Aesthet. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e230146","DOI":"10.1148\/radiol.230146","article-title":"Imaging in Interventional Radiology: 2043 and Beyond","volume":"308","author":"Brock","year":"2023","journal-title":"Radiology"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Gatta, G., Di Grezia, G., Cuccurullo, V., Sardu, C., Iovino, F., Comune, R., Ruggiero, A., Chirico, M., La Forgia, D., and Fanizzi, A. (2021). MRI in Pregnancy and Precision Medicine: A Review from Literature. J. Pers. Med., 12.","DOI":"10.3390\/jpm12010009"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1007\/s10439-020-02553-6","article-title":"A Review on Advances in Intra-operative Imaging for Surgery and Therapy: Imagining the Operating Room of the Future","volume":"48","author":"Zaffino","year":"2020","journal-title":"Ann. Biomed. Eng."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/RMR.0000000000000154","article-title":"MR-Guided Sclerotherapy for the Treatment of Low-Flow Vascular Malformations","volume":"27","author":"Choi","year":"2018","journal-title":"Top. Magn. Reson. Imaging"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1097\/MOO.0000000000000686","article-title":"Imaging-based navigation technologies in head and neck surgery","volume":"29","author":"Eu","year":"2021","journal-title":"Curr. Opin. Otolaryngol. Head. Neck Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1148\/radiol.2233010025","article-title":"Venous vascular malformations in pediatric patients: Comparison of results of alcohol sclerotherapy with proposed MR imaging classification","volume":"223","author":"Goyal","year":"2002","journal-title":"Radiology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"205","DOI":"10.3174\/ajnr.A4518","article-title":"MR Angiographic-Guided Percutaneous Sclerotherapy for Venous Vascular Malformations: A Radiation Dose-Reduction Strategy","volume":"37","author":"Imbesi","year":"2016","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Vollherbst, D.F., Gebhart, P., Kargus, S., Burger, A., Kuhle, R., Gunther, P., Hoffmann, J., Bendszus, M., M\u00f6hlenbruch, M.A., and Meckel, S. (2020). Image-guided percutaneous sclerotherapy of venous malformations of the head and neck: Clinical and MR-based volumetric mid-term outcome. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0241347"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1409","DOI":"10.1001\/archderm.139.11.1409","article-title":"Treatment of venous malformations with sclerosant in microfoam form","volume":"139","author":"Cabrera","year":"2003","journal-title":"Arch. Dermatol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1001\/jamaoto.2020.4353","article-title":"Contemporary Management of Vascular Anomalies of the Head and Neck-Part 1: Vascular Malformations: A Review","volume":"147","author":"Gallant","year":"2021","journal-title":"JAMA Otolaryngol. Head Neck Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s13014-019-1308-y","article-title":"MR-guidance in clinical reality: Current treatment challenges and future perspectives","volume":"14","author":"Corradini","year":"2019","journal-title":"Radiat. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1148\/radiol.2332031213","article-title":"Low-flow vascular malformations: MR-guided percutaneous sclerotherapy in qualitative and quantitative assessment of therapy and outcome","volume":"233","author":"Boll","year":"2004","journal-title":"Radiology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1002\/jmri.25502","article-title":"MR-guided percutaneous sclerotherapy of low-flow vascular malformations: Clinical experience using a 1.5 tesla MR system","volume":"45","author":"DiCamillo","year":"2017","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Bailey, C.R., Herrera, D.G., Neumeister, N., and Weiss, C.R. (2024). Magnetic resonance\u2014Guided treatment of low-flow vascular malformations and the technologies to potentiate adoption. Front. Med., 11.","DOI":"10.3389\/fmed.2024.1319046"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1002\/hed.21274","article-title":"Treatment guideline for hemangiomas and vascular malformations of the head and neck","volume":"32","author":"Zheng","year":"2010","journal-title":"Head Neck"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"8257","DOI":"10.1038\/s41467-023-43966-w","article-title":"A deep unrolled neural network for real-time MRI-guided brain intervention","volume":"14","author":"He","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1093\/eurheartj\/eht327","article-title":"Three-dimensional real-time MRI-guided intracardiac catheter navigation","volume":"35","author":"Gaspar","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3000605231223441","DOI":"10.1177\/03000605231223441","article-title":"Clinical outcomes and predictors of bleomycin polidocanol foam sclerotherapy treatment response in venous malformations","volume":"52","author":"Ni","year":"2024","journal-title":"J. Int. Med. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1016\/j.jvsv.2019.11.022","article-title":"Interim results of bleomycin-polidocanol foam sclerotherapy as a highly efficient technique for venous malformations","volume":"8","author":"Yang","year":"2020","journal-title":"J. Vasc. Surg. Venous Lymphat. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/j.ejvs.2020.01.023","article-title":"Bleomycin Polidocanol Foam (BPF) Stability\u2014In Vitro Evidence for the Effectiveness of a Novel Sclerosant for Venous Malformations","volume":"59","author":"Sun","year":"2020","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.bjoms.2015.05.024","article-title":"Efficacy of sclerotherapy with radio-opaque foam guided by digital subtraction angiography for the treatment of complex venous malformations of the head and neck","volume":"53","author":"Chen","year":"2015","journal-title":"Br. J. Oral Maxillofac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7509\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T02:45:24Z","timestamp":1761273924000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7509"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,23]]},"references-count":24,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217509"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217509","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,10,23]]}}}