RT Journal Article
SR Electronic
T1 Predicting the size of pulmonary arteriovenous malformations on chest computed tomography: a role for transthoracic contrast echocardiography
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 150
OP 159
DO 10.1183/09031936.00133713
VO 44
IS 1
A1 Sebastiaan Velthuis
A1 Elisabetta Buscarini
A1 Johannes J. Mager
A1 Veronique M.M. Vorselaars
A1 Marco W.F. van Gent
A1 Pietro Gazzaniga
A1 Guido Manfredi
A1 Cesare Danesino
A1 Arjen L. Diederik
A1 Jan A. Vos
A1 Silvia Gandolfi
A1 Repke J. Snijder
A1 Cornelis J.J. Westermann
A1 Martijn C. Post
YR 2014
UL http://erj.ersjournals.com/content/44/1/150.abstract
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