title: Pulmonary arteriovenous malformation (PAVM) reperfusion after percutaneous embolization: Sensitivity and specificity of non-enhanced CT.
abstract: OBJECTIVE
  To evaluate the sensitivity and specificity of non-enhanced chest CT to detect reperfusion after pulmonary arteriovenous malformation (PAVM) embolization.
  
  
  METHODS
  The Institutional Review Board approved this retrospective HIPAA-compliant study and waived the need for patient consent. All consecutive patients who underwent PAVM embolization between January 2000 and April 2011 were included. Complex PAVMs and patients without available pre- and/or post-embolization CT were excluded. PAVM artery, aneurysm and vein diameters were measured on non-enhanced chest CT before and after PAVM embolization. Pulmonary angiography (PA) was the reference standard to assess PAVM reperfusion. Reperfusion detection was analyzed with receiver operating characteristic (ROC) curves according to percentage of diameter reduction cut-off. Inter-observer concordance was ascertained with intra-class correlation coefficients (ICCs).
  
  
  RESULTS
  Out of 68 patients with PAVM embolizations, 42 (62%) had 108 PAVMs that met inclusion/exclusion criteria. Areas under the ROC curves for PAVM reperfusion detection were 0.84, 0.87, and 0.78, respectively, for PAVM artery, aneurysm and vein (p>0.05). Sensitivity varied between 51% and 56%, and specificity between 86% and 98% for the <30% diameter reduction cut-off. Sensitivity was between 98% and 100%, and specificity, between 20% and 47% for the <70% diameter reduction cut-off. ICCs for inter-observer concordance were 0.58, 0.88 and 0.68 for percentage reduction of PAVM artery, aneurysm and vein, respectively.
  
  
  CONCLUSIONS
  PAVM diameter reduction cut-offs of <30% and <70%, to detect PAVM reperfusion on non-enhanced CT reported in the literature, would respectively result in low sensitivity and specificity.
authors.affiliation: Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
authors.forename: Chantale
authors.initials: C
authors.lastname: Bélanger
authors.affiliation: Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada; Centre de recherche, Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, QC, Canada.
authors.forename: Carl
authors.initials: C
authors.lastname: Chartrand-Lefebvre
authors.affiliation: Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada; Centre de recherche, Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, QC, Canada.
authors.forename: Gilles
authors.initials: G
authors.lastname: Soulez
authors.affiliation: Respirology Division, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; Montreal HHT Centre, Pneumology Division, CHUM, Montreal, QC, Canada.
authors.forename: Marie E
authors.initials: ME
authors.lastname: Faughnan
authors.affiliation: Centre de recherche, Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, QC, Canada.
authors.forename: Muhammad Ramzan
authors.initials: MR
authors.lastname: Tahir
authors.affiliation: Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Giroux
authors.affiliation: Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Gilbert
authors.affiliation: Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Perreault
authors.affiliation: Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
authors.forename: Louis
authors.initials: L
authors.lastname: Bouchard
authors.affiliation: Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada.
authors.forename: Vincent L
authors.initials: VL
authors.lastname: Oliva
authors.affiliation: Department of Radiology, Centre hospitalier de l'Université de Montréal (CHUM), Montreal, QC, Canada; Centre de recherche, Centre hospitalier de l'Université de Montreal (CRCHUM), Montreal, QC, Canada. Electronic address: eric.therasse.chum@ssss.gouv.qc.ca.
authors.forename: Eric
authors.initials: E
authors.lastname: Therasse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001164:Arteriovenous Fistula / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D001165:Arteriovenous Malformations / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: CT; Pulmonary arteriovenous malformation; Reperfusion