Comprehensive Systematic Review and Meta-Analysis on Vascular Malformation Diagnostics

Abstract

Vascular malformations (VMs) are congenital anomalies of blood or lymphatic vessels that can lead to hemorrhage, pain, and functional impairment if not accurately diagnosed. A systematic search of PubMed, Scopus, Web of Science, and Embase was performed up to October 2025, following PRISMA 2020 guidelines. Studies assessing diagnostic accuracy using a recognized gold standard such as Digital Subtraction Angiography (DSA) or histopathology were included. Out of 1,237 records identified, 22 studies met the eligibility criteria for qualitative and quantitative synthesis.

CTA demonstrated excellent diagnostic utility for detecting arteriovenous and intracranial vascular malformations, with advanced techniques such as 4D-CTA and dual-energy CTA achieving high sensitivity and specificity comparable to DSA. MRA showed superior soft-tissue contrast and non-invasive characterization of lesion extent, with Arterial Spin Labeling (ASL-MRI) reaching pooled sensitivity and specificity of 94% and 99%, respectively (AUC = 0.98). Doppler US remained valuable as a first-line, real-time tool for superficial or peripheral lesions, particularly in pediatric and follow-up settings, despite operator dependency and limited depth penetration.

Collectively, these findings affirm that no single imaging modality is universally optimal. CTA provides rapid assessment in acute conditions, MRA offers comprehensive soft-tissue delineation without radiation, and Doppler US serves as an accessible screening method. A multimodality diagnostic approach ensures accurate characterization, enhances treatment planning, and minimizes invasive procedures, contributing significantly to improved clinical outcomes for patients with vascular malformations. The present comprehensive systematic review and meta-analysis aimed to evaluate and compare the diagnostic accuracy of Computed Tomography Angiography (CTA), Magnetic Resonance Angiography (MRA), and Doppler Ultrasound (US) in detecting various types of vascular malformations.