title: ACR Appropriateness Criteria Clinically Suspected Pulmonary Arteriovenous Malformation.
abstract: Pulmonary arteriovenous malformations are often included in the differential diagnosis of common clinical presentations, including hypoxemia, hemoptysis, brain abscesses, and paradoxical stroke, as well as affecting 30% to 50% of patients with hereditary hemorrhagic telangiectasia (HHT). Various imaging studies are used in the diagnostic and screening settings, which have been reviewed by the ACR Appropriateness Criteria Vascular Imaging Panel. Pulmonary arteriovenous malformation screening in patients with HHT is commonly performed with transthoracic echocardiographic bubble study, followed by CT for positive cases. Although transthoracic echocardiographic bubble studies and radionuclide perfusion detect right-to-left shunts, they do not provide all of the information needed for treatment planning and may remain positive after embolization. Pulmonary angiography is appropriate for preintervention planning but not as an initial test. MR angiography has a potential role in younger patients with HHT who may require lifelong surveillance, despite lower spatial resolution compared with CT. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: University of Virginia Health System, Charlottesville, Virginia. Electronic address: mhanley@virginia.edu.
authors.forename: Michael
authors.initials: M
authors.lastname: Hanley
authors.affiliation: Rush University Medical Center, Chicago, Illinois.
authors.forename: Osmanuddin
authors.initials: O
authors.lastname: Ahmed
authors.affiliation: Scripps Green Hospital, La Jolla, California, Society for Vascular Surgery.
authors.forename: Ankur
authors.initials: A
authors.lastname: Chandra
authors.affiliation: Moffitt Cancer Center, Tampa, Florida.
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Gage
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, American College of Cardiology.
authors.forename: Marie D
authors.initials: MD
authors.lastname: Gerhard-Herman
authors.affiliation: Stanford University School of Medicine, Stanford, California.
authors.forename: Michael
authors.initials: M
authors.lastname: Ginsburg
authors.affiliation: Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio, American College of Cardiology.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Gornik
authors.affiliation: Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Pamela T
authors.initials: PT
authors.lastname: Johnson
authors.affiliation: University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Isabel B
authors.initials: IB
authors.lastname: Oliva
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ptak
authors.affiliation: Brigham and Women's Hospital, Boston, Massachusetts, American College of Cardiology.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Steigner
authors.affiliation: Baylor College of Medicine, Houston, Texas.
authors.forename: Richard
authors.initials: R
authors.lastname: Strax
authors.affiliation: Ottawa Hospital Research Institute and the Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Rybicki
authors.affiliation: University of Chicago, Chicago, Illinois.
authors.forename: Karin E
authors.initials: KE
authors.lastname: Dill
mesh_terms: D001164:Arteriovenous Fistula / Q000175:diagnosis*; D000072226:Computed Tomography Angiography / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic; D011651:Pulmonary Artery / Q000002:abnormalities*; D011667:Pulmonary Veins / Q000002:abnormalities*; D011871:Radiology / Q000592:standards*; D012955:Societies, Medical / Q000592:standards; D014481:United States
keywords: Appropriateness Criteria; Osler-Weber-Rendu syndrome; chest CT; hereditary hemorrhagic telangiectasia; pulmonary arteriovenous malformations; transthoracic echocardiography