Contrast echocardiography grading predicts pulmonary arteriovenous malformations on CT

Area of Science:

• Cardiology
• Radiology
• Genetics

Background:

• Pulmonary arteriovenous malformations (PAVMs) pose serious health risks if untreated.
• Transthoracic contrast echocardiography (TTCE) is the recommended screening tool for PAVMs in hereditary hemorrhagic telangiectasia (HHT).
• A validated grading system for TTCE is needed to assess PAVM presence.

Purpose of the Study:

• To validate a proposed TTCE grading system.
• To determine the positive predictive value (PPV) of TTCE grades for identifying PAVMs.
• To assess the utility of TTCE grading in the PAVM screening algorithm.

Main Methods:

• Retrospective review of 90 HHT patients with positive TTCE results.
• TTCE results were graded (1-4) based on opacification intensity and microcavitation delay.
• Comparison of TTCE grades with thoracic CT findings for PAVM detection.

Main Results:

• A significant association (p < 0.0001) was found between TTCE grade and PAVM presence on CT.
• The PPV for TTCE grades 1, 2, 3, and 4 were 0.02, 0.25, 0.56, and 1.0, respectively.
• CT-detectable PAVMs were present in 17% of all screened patients and 27% of those with positive TTCE.

Conclusions:

• Higher TTCE shunt grades strongly predict the presence of PAVMs.
• The TTCE grading system is a valuable tool for guiding PAVM screening decisions in HHT patients.