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01-08-2016 | Chest

Vein Diameter on Unenhanced Multidetector CT Predicts Reperfusion of Pulmonary Arteriovenous Malformation after Embolotherapy

Authors: Delphine Gamondès, Salim Si-Mohamed, Vincent Cottin, Sophie Gonidec, Loïc Boussel, Philippe Douek, Didier Revel

Published in: European Radiology | Issue 8/2016

Abstract

Objective

To evaluate the value of the diameter of the draining vein of pulmonary arteriovenous malformation (PAVM) on unenhanced chest MDCT in diagnosing reperfusion after percutaneous vaso-occlusion therapy.

Methods

We retrospectively reviewed our long-term experience of patients with hereditary haemorrhagic telangiectasia and selected cases on the following criteria: an initial pulmonary angiogram with embolotherapy of at least one PAVM, a follow-up MDCT examination in the following year followed by a second pulmonary angiogram with embolotherapy if needed. Follow-up unenhanced chest MDCT examinations were analyzed blindly from results of pulmonary artery angiogram and clinical data, the diameter of the efferent vein close to the PAVM sac was measured, then compared to those of pulmonary artery angiogram as a gold standard.

Results

Eighty-eight of 100 patients met inclusion criteria, in whom 62 of 176 PAVMs were reperfused at angiogram. The mean diameter of the efferent vein on MDCT was 4.3 ± 2.1 mm in patent PAVMs and 1.8 ± 0.9 mm in non-patent PAVMs (p < 0.0001). The optimal cutoff diameter based on ROC analysis was 2.5 mm (sensitivity = 98.4 %; specificity = 87.7 %).

Conclusion

A diameter of the draining vein of PAVM of 2.5 mm or greater on unenhanced MDCT is a strong predictor of reperfusion.

Key points

• Diameter of draining vein of 2.5 mm or greater is associated with reperfusion.

• Unenhanced chest MDCT predicts reperfusion of PAVMs with good sensitivity and specificity.

• Unenhanced MDCT can guide a decision of repeat pulmonary angiogram and embolotherapy.

• The mean vein diameter change of PAVMs occluded at follow-up is 3.8 mm.

• Overall success rate after a median of 6 months embolotherapy was 64.7 %.

Guttmacher AE, Marchuk DA, White RI Jr (1995) Hereditary hemorrhagic telangiectasia. N Engl J Med 333:918–924CrossRefPubMed

Cottin V, Chinet T, Lavolé A et al (2007) Pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: a series of 126 patients. Medicine (Baltimore) 86(1):1–17CrossRef

Shovlin CL, Guttmacher AE, Buscarini E et al (2000) Diagnostic criteria for hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome). Am J Med Genet 91(1):66–67CrossRefPubMed

Trerotola SO, Pyeritz RE (2010) PAVM embolization: an update. Am J Roentgenol 195(4):837–845CrossRef

White RI, Lynch-Nyhan A, Terry P et al (1988) Pulmonary arteriovenous malformations: techniques and long-term outcome of embolotherapy. Radiology 169(3):663–669CrossRefPubMed

Faughnan ME, Palda VA, Garcia-Tsao G et al (2011) International guidelines for the diagnosis and management of hereditary haemorrhagic telangiectasia. J Med Genet 48(2):73–87CrossRefPubMed

Lee DW, White RI, Egglin TK et al (1997) Embolotherapy of large pulmonary arteriovenous malformations: long-term results. Ann Thorac Surg 64(4):930–939, discussion 939–40CrossRefPubMed

Mager JJ, Overtoom TTC, Blauw H, Lammers JWJ, Westermann CJJ (2004) Embolotherapy of pulmonary arteriovenous malformations: long-term results in 112 patients. J Vasc Interv Radiol 15(5):451–456CrossRefPubMed

Milic A, Chan RP, Cohen JH, Faughnan ME (2005) Reperfusion of pulmonary arteriovenous malformations after embolotherapy. J Vasc Interv Radiol 16(12):1675–1683CrossRefPubMed

10.

Remy-Jardin M, Dumont P, Brillet P-Y, Dupuis P, Duhamel A, Remy J (2006) Pulmonary arteriovenous malformations treated with embolotherapy: helical CT evaluation of long-term effectiveness after 2-21-year follow-up. Radiology 239(2):576–585CrossRefPubMed

11.

Pollak JS, Saluja S, Thabet A, Henderson KJ, Denbow N, White RI (2006) Clinical and anatomic outcomes after embolotherapy of pulmonary arteriovenous malformations. J Vasc Interv Radiol 17(1):35–44, quiz 45CrossRefPubMed

12.

Cottin V, Plauchu H, Bayle J-Y, Barthelet M, Revel D, Cordier J-F (2004) Pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia. Am J Respir Crit Care Med 169(9):994–1000CrossRefPubMed

13.

Lee WL, Graham AF, Pugash RA et al (2003) Contrast echocardiography remains positive after treatment of pulmonary arteriovenous malformations. Chest 123(2):351–358CrossRefPubMed

14.

Remy J, Remy-Jardin M, Giraud F, Wattinne L (1994) Angioarchitecture of pulmonary arteriovenous malformations: clinical utility of three-dimensional helical CT. Radiology 191(3):657–664CrossRefPubMed

15.

Gossage JR, Kanj G (1998) Pulmonary arteriovenous malformations. A state of the art review. Am J Respir Crit Care Med 1(2):643–661CrossRef

16.

Pelage JP, Lagrange C, Chinet T et al (2007) Embolization of localized pulmonary arteriovenous malformations in adults. J Radiol 88(3 Pt 1):367–376CrossRefPubMed

17.

Gupta S, Faughnan ME, Bayoumi AM (2009) Embolization for pulmonary arteriovenous malformation in hereditary hemorrhagic telangiectasia: a decision analysis. Chest 136(3):849–858CrossRefPubMed

18.

Brillet P-Y, Dumont P, Bouaziz N et al (2007) Pulmonary arteriovenous malformation treated with embolotherapy: systemic collateral supply at multidetector CT angiography after 2-20-year follow-up. Radiology 242(1):267–276CrossRefPubMed

19.

Prasad V, Chan RP, Faughnan ME (2004) Embolotherapy of pulmonary arteriovenous malformations: efficacy of platinum versus stainless steel coils. J Vasc Interv Radiol 15(2 Pt 1):153–160CrossRefPubMed

Title: Vein Diameter on Unenhanced Multidetector CT Predicts Reperfusion of Pulmonary Arteriovenous Malformation after Embolotherapy
Authors: Delphine Gamondès
Salim Si-Mohamed
Vincent Cottin
Sophie Gonidec
Loïc Boussel
Philippe Douek
Didier Revel
Publication date: 01-08-2016
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 8/2016
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-015-4090-8

At a glance: The STEP trials

Springer Medicine

Vein Diameter on Unenhanced Multidetector CT Predicts Reperfusion of Pulmonary Arteriovenous Malformation after Embolotherapy

Abstract

Objective

Methods

Results

Conclusion

Key points

At a glance: The STEP trials

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Key points

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