Document Detail

Sensitivity and specificity of radioisotope right-left shunt measurements and pulse oximetry for the early detection of pulmonary arteriovenous malformations.
MedLine Citation:
PMID:  9925070     Owner:  NLM     Status:  MEDLINE    
STUDY OBJECTIVES: To assess the effectiveness of pulse oximetry and radioisotope measurement of right-to-left (R-L) shunt for the early detection of pulmonary arteriovenous malformations (PAVMs) in patients with hereditary hemorrhagic telangiectasia (HHT). DESIGN: Patients with HHT had serial measurements of the following: (1) arterial oxygen saturation (SaO2) by pulse oximetry in erect and supine positions, and on maximal exercise using cycle ergometry; (2) quantitative radioisotope measurements of R-L shunt using IV 99mTc-labeled macroaggregates of albumin; and (3) routine pulmonary function. After percutaneous transcatheter embolization of all PAVMs with feeding vessel diameters > 3 mm, residual PAVMs were assessed with selective digital subtraction pulmonary angiography. Using postembolization angiography as the "gold standard," SaO2 and radioisotope shunt measurements after embolization were analyzed retrospectively using logistic regression to assess the ability of each test to predict for the presence of residual PAVMs. RESULTS: Of the 66 patients included, 40 had small PAVMs remaining postembolization. Using univariate logistic regression, radioisotope shunt and erect saturation showed a significant relationship with the presence of residual PAVMs (p=0.001, 0.005, respectively). Erect SaO2 < or = 96% had 73% sensitivity and 35% specificity for detecting PAVMs. Radioisotope shunt >3.5% of cardiac output had 87% sensitivity and 61% specificity for detecting PAVMs. CONCLUSIONS: These results confirm that noninvasive measurements are useful in the screening of patients with HHT for the presence of PAVMs without need for angiography and its associated risks, and that radionuclide scanning is better than pulse oximetry.
R D Thompson; J Jackson; A M Peters; C J Doré; J M Hughes
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Chest     Volume:  115     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1999 Jan 
Date Detail:
Created Date:  1999-02-05     Completed Date:  1999-02-05     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  109-13     Citation Subset:  AIM; IM    
Department of Respiratory Medicine, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom.
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MeSH Terms
Angiography, Digital Subtraction
Arteriovenous Malformations / diagnosis*,  physiopathology,  therapy
Embolization, Therapeutic
Lung / blood supply*
Lung Volume Measurements
Sensitivity and Specificity
Technetium Tc 99m Aggregated Albumin / diagnostic use*
Telangiectasia, Hereditary Hemorrhagic / diagnosis*,  physiopathology,  therapy
Reg. No./Substance:
0/Technetium Tc 99m Aggregated Albumin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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