Pulmonary arteriovenous malformation (PAVM) embolization: prediction of angiographically-confirmed recanalization according to PAVM Diameter changes on CT

Jihoon Hong,Jaehee Lee,Sang Yub Lee,Chang-Ho Kim,Hyewon Seo,Jae-Kwang Lim,Jung Guen Cha,Seung-Ick Cha,Jongmin Park

doi:10.1186/s42155-021-00207-9

Abstract

BackgroundTo assess pulmonary arteriovenous malformation (PAVM) recanalization after embolization based on PAVM diameter changes on computed tomography (CT), with pulmonary angiography used as a gold standard.MethodsA retrospective review was done of patients from 2008 to 2019 with a PAVM treated with endovascular embolization. The treatment outcome was determined by conventional angiography. Follow-up pulmonary angiography was performed when recanalization was suspected on CT, or embolization of all lesions in multiple PAVM patients could not be completed in a single session. Patients who had no preprocedural or follow-up CT were excluded. Draining vein, feeding artery, and venous sac diameter were measured on CT, and diameter reduction rates were compared with the widely-used, binary 70 % criteria.ResultsForty-one patients with 114 PAVMs were treated during the study period. Eight patients with 50 PAVMs met the inclusion criteria. Mean vein, artery, and venous sac diameter reduction rates were as follows: 59.2 ± 9.3 %, 47.5 ± 10.6 %, and 62.6 ± 13.2 %, respectively, in the occluded group and 5.4 ± 19.5 %, 11.3 ± 17.7 %, and 26.8 ± 14.2 %, respectively, in the recanalized group. The area under the receiver operating characteristic curves for PAVM recanalization for the draining vein was 1.00, showing a better result than the artery (0.97) and sac (0.99). Patients showed > 42 % draining vein diameter reduction in the occluded group and < 32 % in the recanalized group. The widely-used 70 % criteria showed low specificity for predicting recanalization (draining vein, 7.3 %; venous sac, 41.7 %) but 100 % sensitivity for both the draining vein and venous sac.ConclusionsThe widely-used 70 % binary criteria showed limited performance in predicting outcomes in this angiographically-confirmed case series. Further investigations are warranted to establish a strategy for detecting recanalization after PAVM embolization.

Highlights

To assess pulmonary arteriovenous malformation (PAVM) recanalization after embolization based on pulmonary arteriovenous malformations (PAVMs) diameter changes on computed tomography (CT), with pulmonary angiography used as a gold standard
Pulmonary angiography is considered as a gold standard for evaluating PAVM recanalization (Faughnan et al 2011); due to its invasiveness, chest computed tomography (CT) is preferred as the follow-up modality in clinical practice
Patient demographics In total, 41 patients with 114 PAVMs were treated with transcatheter embolization during 54 treatment sessions

Summary

Introduction

To assess pulmonary arteriovenous malformation (PAVM) recanalization after embolization based on PAVM diameter changes on computed tomography (CT), with pulmonary angiography used as a gold standard. Several methods have been used to assess treatment outcomes in follow-up CT (Lee et al 1997; Mager et al 2004; Pollak et al 2006; Prasad et al 2004; Remy-Jardin et al 2006; Milic et al 2005; Hart et al 2010; Brillet et al 2007; Letourneau-Guillon et al 2010; Trerotola and Pyeritz 2010; Woodward et al 2013; Kajiwara et al 2014; Rabellino et al 2014; Conrad et al 2015). The cut-off value of vessel reduction rates for detecting recanalization was compared with the existing 70 % criteria

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Results

Discussion

Conclusion