Digital subtraction pulmonary arteriography versus multidetector CT in the detection of pulmonary arteriovenous malformations

Asad Nawaz, Harold I Litt, S William Stavropoulos, Sridhar R Charagundla, Richard D Shlansky-Goldberg, David B Freiman, Jesse Chittams, Reed E Pyeritz, Scott O Trerotola
Journal of Vascular and Interventional Radiology: JVIR 2008, 19 (11): 1582-8

PURPOSE: To compare digital subtraction pulmonary arteriography (PA) with 16-detector row computed tomography (CT) in the detection of suspected pulmonary arteriovenous malformations (PAVMs) in patients with hereditary hemorrhagic telangiectasia (HHT).

MATERIALS AND METHODS: Eighteen nonconsecutive patients (median age, 47.5 years; range, 26-78 y) with a total of 42 PAVMs were included over a period of 2.75 years. At the authors' institution, all patients with HHT and their family members undergo contrast echocardiography. Positive contrast echocardiography findings prompt multidetector CT (MDCT) scanning, which, in the case of positive findings, is then followed by digital subtraction PA and embolotherapy as appropriate. Catheter-based PA was performed in the study group drawn from the group that underwent MDCT and PA. Evaluation of PAVM presence, location, and type in PA studies was conducted by three blinded interventional radiology physician reviewers and compared with the readings of MDCT studies by three blinded MDCT physician reviewers. Consensus review was performed after blinded readings were complete.

RESULTS: Whole-lung analysis (ie, correct identification of a lesion anywhere in the lung) showed MDCT readings to have a mean sensitivity of 83% and specificity of 78% and PA readings to have a mean sensitivity of 70% and specificity of 100%. Lobar analysis (ie, correct identification of a lesion in a given lobe) showed MDCT readings to have a mean sensitivity of 72% and specificity of 93% and PA readings to have a mean sensitivity of 68% and specificity of 100%.

CONCLUSIONS: According to the definitions in this study, MDCT provides greater sensitivity in the detection of PAVM than digital subtraction PA, but does so with a loss in specificity, and the differences depend on the level analyzed (ie, lung vs lobe).

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