title: Predicting the size of pulmonary arteriovenous malformations on chest computed tomography: a role for transthoracic contrast echocardiography.
abstract: This study aimed to investigate whether pulmonary shunt grade on transthoracic contrast echocardiography (TTCE) predicts the size of pulmonary arteriovenous malformations (PAVMs) on chest computed tomography (CT) and subsequent feasibility for transcatheter embolotherapy. We prospectively included 772 persons with possible or definite hereditary haemorrhagic telangiectasia, who underwent both TTCE and chest CT for screening of PAVMs. A quantitative three-point grading scale was used to classify the pulmonary shunt size on TTCE (grade 1-3). Transcatheter embolotherapy was performed for PAVMs deemed large enough for endovascular closure on chest CT. TTCE documented pulmonary shunting in 510 (66.1%) patients. The positive predictive value of a pulmonary shunt grade 1, 2 and 3 on TTCE for presence of PAVMs on chest CT was 13.4%, 45.3% and 92.5%, respectively (p<0.001). None of the 201 persons with a pulmonary shunt grade 1 on TTCE had PAVMs on chest CT large enough for transcatheter embolotherapy, while 38 (25.3%) and 123 (77.4%) individuals with a pulmonary shunt grade 2 and 3 on TTCE, respectively, underwent endovascular closure of PAVMs. Pulmonary shunt grade on TTCE predicts the size of PAVMs on chest CT and their feasibility for subsequent transcatheter embolotherapy. Chest CT can be safely withheld from all persons with a pulmonary shunt grade 1 on TTCE, as any PAVM found in these subjects will be too small for transcatheter embolotherapy.
authors.affiliation: Dept of Cardiology, St Antonius Hospital, Nieuwegein S.Velthuis@antoniusziekenhuis.nl.
authors.forename: Sebastiaan
authors.initials: S
authors.lastname: Velthuis
authors.affiliation: Dept of Gastroenterology, Maggiore Hospital, Crema.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Buscarini
authors.affiliation: Dept of Pulmonology, St Antonius Hospital, Nieuwegein.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Mager
authors.affiliation: Dept of Cardiology, St Antonius Hospital, Nieuwegein.
authors.forename: Veronique M M
authors.initials: VM
authors.lastname: Vorselaars
authors.affiliation: Dept of Cardiology, St Antonius Hospital, Nieuwegein.
authors.forename: Marco W F
authors.initials: MW
authors.lastname: van Gent
authors.affiliation: Dept of Cardiology, Maggiore Hospital, Crema.
authors.forename: Pietro
authors.initials: P
authors.lastname: Gazzaniga
authors.affiliation: Dept of Gastroenterology, Maggiore Hospital, Crema.
authors.forename: Guido
authors.initials: G
authors.lastname: Manfredi
authors.affiliation: Dept of Molecular Medicine, University of Pavia and IRCCS, S. Matteo, Pavia.
authors.forename: Cesare
authors.initials: C
authors.lastname: Danesino
authors.affiliation: Dept of Radiology, St Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Arjen L
authors.initials: AL
authors.lastname: Diederik
authors.affiliation: Dept of Radiology, St Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Vos
authors.affiliation: Dept of Radiology, Maggiore Hospital, Crema, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Gandolfi
authors.affiliation: Dept of Pulmonology, St Antonius Hospital, Nieuwegein.
authors.forename: Repke J
authors.initials: RJ
authors.lastname: Snijder
authors.affiliation: Dept of Pulmonology, St Antonius Hospital, Nieuwegein.
authors.forename: Cornelis J J
authors.initials: CJ
authors.lastname: Westermann
authors.affiliation: Dept of Cardiology, St Antonius Hospital, Nieuwegein.
authors.forename: Martijn C
authors.initials: MC
authors.lastname: Post
mesh_terms: D000328:Adult; D000368:Aged; D001165:Arteriovenous Malformations / Q000175:diagnosis* / Q000000981:diagnostic imaging; D004452:Echocardiography; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011336:Probability; D011446:Prospective Studies; D013902:Radiography, Thoracic; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications; D014057:Tomography, X-Ray Computed