PT  - JOURNAL ARTICLE
AU  - Sebastiaan Velthuis
AU  - Elisabetta Buscarini
AU  - Johannes J. Mager
AU  - Veronique M.M. Vorselaars
AU  - Marco W.F. van Gent
AU  - Pietro Gazzaniga
AU  - Guido Manfredi
AU  - Cesare Danesino
AU  - Arjen L. Diederik
AU  - Jan A. Vos
AU  - Silvia Gandolfi
AU  - Repke J. Snijder
AU  - Cornelis J.J. Westermann
AU  - Martijn C. Post
TI  - Predicting the size of pulmonary arteriovenous malformations on chest computed tomography: a role for transthoracic contrast echocardiography
AID  - 10.1183/09031936.00133713
DP  - 2014 Jan 01
TA  - European Respiratory Journal
PG  - erj01337-2013
4099  - http://erj.ersjournals.com/content/early/2014/03/06/09031936.00133713.short
4100  - http://erj.ersjournals.com/content/early/2014/03/06/09031936.00133713.full
AB  - 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. Chest CT can be safely withheld from persons with pulmonary shunt grade 1 on TTCE http://ow.ly/sUAps