Document Detail


MR angiography for detection of pulmonary arteriovenous malformations in patients with hereditary hemorrhagic telangiectasia.
MedLine Citation:
PMID:  18356434     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The purpose of our study was to evaluate contrast-enhanced MR angiography (CE-MRA) as a screening procedure for the detection of pulmonary arteriovenous malformations (AVMs) in patients with hereditary hemorrhagic telangiectasia (HTT). MATERIALS AND METHODS: Two hundred three consecutive subjects (patients with diagnosed HHT or first-degree relatives; 87 males, 116 females; 6-83 years old) underwent pulmonary CE-MRA with 0.1 mmol/kg of gadobenate dimeglumine. The presence of pulmonary AVM was scored as 0 (none present), 1 (definitely present), or 2 (uncertain) and was evaluated by patient sex and pulmonary AVM size (< 5, 5-10, 11-15, 16-20, > 20 mm). Patients scored as 1 or 2 with at least one pulmonary AVM of > or = 5 mm underwent conventional pulmonary angiography for possible embolization. Pulmonary AVM detection on CE-MRA and pulmonary angiography was compared using paired Student's t tests. RESULTS: The presence of pulmonary AVM was considered definite in 56 of 203 (27.6%) patients and uncertain in one of 203 patients on CE-MRA. Of 156 pulmonary AVMs detected on CE-MRA, 124 (49 in 27 males, 75 in 30 females) were detected on first screening CE-MRA and 32 on follow-up CE-MRA. Pulmonary AVMs on CE-MRA were solitary in 25 patients, multiple in 31 patients, and predominantly small (< 5 mm, n = 32; 5-10 mm, n = 45). Significantly (p < 0.0001) fewer pulmonary AVMs were detected on pulmonary angiography (76/96 [79.2%] evaluable pulmonary AVMs in 40 patients before first pulmonary angiography; 92/119 [77.3%] pulmonary AVMs overall). Three-dimensional maximum-intensity-projection reconstructions permitted improved pulmonary AVM visualization and embolization planning of complex pulmonary AVMs. CONCLUSION: CE-MRA is suitable for screening patients with HHT. It permits accurate detection and staging of pulmonary AVMs, appropriate differentiation of lesions requiring embolization and accurate orientation, and visualization and planning of embolization therapy.
Authors:
Guenther Schneider; Michael Uder; Michael Koehler; Miles A Kirchin; Alexander Massmann; Arno Buecker; Urban Geisthoff
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  AJR. American journal of roentgenology     Volume:  190     ISSN:  1546-3141     ISO Abbreviation:  AJR Am J Roentgenol     Publication Date:  2008 Apr 
Date Detail:
Created Date:  2008-03-21     Completed Date:  2008-05-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7708173     Medline TA:  AJR Am J Roentgenol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  892-901     Citation Subset:  AIM; IM    
Affiliation:
Department of Diagnostic and Interventional Radiology, University Hospital of Saarland, 66421 Homburg/Saar, Germany. guentherschneider@googlemail.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Arteriovenous Malformations / diagnosis*,  etiology,  therapy
Child
Contrast Media
Embolization, Therapeutic
Female
Humans
Image Interpretation, Computer-Assisted
Magnetic Resonance Angiography*
Male
Meglumine / analogs & derivatives,  diagnostic use
Middle Aged
Organometallic Compounds / diagnostic use
Pulmonary Artery / abnormalities*
Pulmonary Veins / abnormalities*
Telangiectasia, Hereditary Hemorrhagic / complications*
Chemical
Reg. No./Substance:
0/Contrast Media; 0/Organometallic Compounds; 113662-23-0/gadobenic acid; 6284-40-8/Meglumine

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