title: Carotid ultrasound for pulmonary arteriovenous malformation screening.
abstract: OBJECTIVE
  In patients with hereditary hemorrhagic telangiectasia (HHT), pulmonary arteriovenous malformations (PAVMs) can cause serious neurological complications. Our aim was to evaluate the potential of contrast-enhanced Doppler ultrasound (CE-US) of the common carotid artery as a screening test for detection of PAVMs.
  
  
  METHODS
  A total of 124 consecutive patients with HHT or a positive family history underwent screening for PAVMs with CE-US and thoracic contrast-enhanced magnetic resonance angiography (CE-MRA). CE-US was performed after receiving (D)-galactose microparticulate, and CE-MRA with gadobenate dimeglumine. Twenty-five patients with confirmed PAVMs were referred to conventional pulmonary catheter angiography (PA). Findings on CE-US and CE-MRA were evaluated using contingency tables and McNemar's test.
  
  
  RESULTS
  Using CE-MRA as the reference test, CE-US had a sensitivity of 100%, a specificity of 87%, and a negative predictive value of 100%. In 25 patients who underwent PA, PAVMs that had been diagnosed on CE-US and CE-MRA were confirmed. Of the PAVMs detected by CE-MRA, 24% were not identified on PA.
  
  
  CONCLUSIONS
  CE-US is a simple, minimally invasive screening method that can easily be performed in different settings. CE-US can predict PAVMs with high probability of success. CE-US may be a simple alternative to transthoracic echocardiography in the assessment of PAVMs in certain HHT-patients.
authors.affiliation: Department of Cardiology, Städtisches Krankenhaus Pirmasens gGmbH, Pettenkoferstr. 22, 66955 Pirmasens, Germany, Tel: 0049-6331-714-1266.
authors.forename: Anita
authors.initials: A
authors.lastname: Yanna-Schulze
authors.affiliation: Medical Faculty of the Saarland University, 66421 Homburg/Saar, Germany Department of Diagnostic and Interventional Radiology, Saarland University Hospital, 66421 Homburg/Saar, Germany.
authors.forename: Günther
authors.initials: G
authors.lastname: Schneider
authors.affiliation: Department of Diagnostic and Interventional Radiology, Saarland University Hospital, 66421 Homburg/Saar, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Maßmann
authors.affiliation: Department of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Hospital, 66421 Homburg/ Saar, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Gräber
authors.affiliation: Department of Otorhinolaryngology, Essen University Hospital, 45147 Essen, Germany.
authors.forename: Urban W
authors.initials: UW
authors.lastname: Geisthoff
keywords: Hereditary hemorrhagic telangiectasia; contrast-enhanced ultrasound; pulmonary arteriovenous malformation; screening