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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Carotid ultrasound for pulmonary arteriovenous malformation screening
Anita Yanna-Schulze1, Günther Schneider2, Alexander Maßmann3
1Department of Cardiology, Städtisches Krankenhaus Pirmasens gGmbH, Pettenkoferstr. 22, 66955 Pirmasens, Germany, Tel: 0049-6331-714-1266.
Insights
Contrast-enhanced ultrasound (CE-US) effectively screens for pulmonary arteriovenous malformations (PAVMs) in hereditary hemorrhagic telangiectasia (HHT) patients. This simple method shows high sensitivity and specificity, offering a potential alternative to other imaging techniques.
Area of Science:
- Vascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Pulmonary arteriovenous malformations (PAVMs) in hereditary hemorrhagic telangiectasia (HHT) can lead to severe neurological issues.
- Accurate and accessible screening for PAVMs is crucial in HHT management.
Purpose of the Study:
- To assess the utility of contrast-enhanced ultrasound (CE-US) of the common carotid artery for detecting PAVMs in HHT patients.
- To compare the diagnostic performance of CE-US against established imaging modalities.
Main Methods:
- 124 HHT patients or those with a positive family history underwent screening using CE-US and thoracic contrast-enhanced magnetic resonance angiography (CE-MRA).
- CE-US utilized (D)-galactose microparticulate, while CE-MRA used gadobenate dimeglumine.
- Twenty-five patients with confirmed PAVMs proceeded to pulmonary angiography (PA) for further evaluation.
Main Results:
- CE-US demonstrated 100% sensitivity, 87% specificity, and 100% negative predictive value when compared to CE-MRA.
- PAVMs identified by CE-US and CE-MRA were confirmed via PA in 25 patients.
- A significant portion (24%) of PAVMs detected by CE-MRA were not identified by PA.
Conclusions:
- CE-US is a simple, minimally invasive screening tool for PAVMs in HHT patients, suitable for various clinical settings.
- CE-US exhibits a high probability of successfully predicting PAVMs.
- CE-US may serve as a practical alternative to transthoracic echocardiography for PAVM assessment in select HHT patients.
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.
Conclusion:
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.
