ACR Appropriateness Criteria® Pulmonary Arteriovenous Malformation (PAVM): 2023 Update

Area of Science:

• Radiology
• Vascular Medicine
• Genetics

Background:

• Pulmonary arteriovenous malformations (PAVMs) are common in hereditary hemorrhagic telangiectasia (HHT), affecting 30-50% of patients.
• Clinical manifestations range from asymptomatic disease to severe complications like stroke, hypoxemia, and heart failure due to right-to-left shunting.

Purpose of the Study:

• To review and present appropriate imaging studies for the diagnosis and treatment of PAVMs based on clinical scenarios.
• To provide evidence-based guidelines for the management of PAVMs.

Main Methods:

• The document reviews appropriate imaging studies for PAVMs, referencing the American College of Radiology Appropriateness Criteria.
• Methodologies include systematic analysis of peer-reviewed literature and expert consensus, adapting principles like GRADE and the RAND/UCLA Appropriateness Method.

Main Results:

• Radiology is crucial for both diagnosing PAVMs and guiding their treatment.
• The review outlines specific imaging modalities recommended for various clinical presentations of PAVMs.

Conclusions:

• Appropriate imaging selection is vital for effective PAVM diagnosis and management in HHT patients.
• These evidence-based guidelines aid clinicians in choosing the most suitable imaging studies for PAVM-related conditions.