Similar findings have been reported in 28 PAVMs in 10 patients by Kawai et al [56]. In a recent study, Hong et al [57] studied the feasibility of time-resolved MRA in evaluating the feeding arteries and reperfusion after embolization of PAVMs in 9 patients with 62 PAVMs. They found a sensitivity and specificity of 100% for detection of reperfusion compared to catheter angiography as the reference standard. The visibility of the feeding arteries was compared to CT, and they found good correlation between 0.76 and 0.79 with 2 readers when using 3- D maximum intensity projection images. Time-resolved MRA also has the advantage of detecting reperfusion after repeat embolization for persistence as the burden of coiling will be greater leading to more metallic artifacts on CT [58]. MRA Pulmonary Arteries Without IV Contrast There is no role for the routine use of MRA pulmonary angiography without IV contrast in the workup of a patient with treated PAVM. Radiography Chest The radiographic appearance of a lower lobe pulmonary nodule with a branching afferent artery and dilated efferent vein defines the classical appearance of PAVM on chest radiography. The sensitivity of chest radiography is 60% to 70% with a 98% specificity when the classical findings are present [36]. The afferent and efferent vasculature and smaller PAVMs may be difficult to see on a single-view chest radiograph. Best diagnostic results are obtained when a 2-view chest radiograph, posteroanterior view, and lateral view is performed [37]. Chest radiography has limited usefulness to detect recurrent disease in the setting of prior treated PAVM. US Echocardiography Transesophageal There is no role for TEE as a standalone diagnostic tool in the evaluation of PAVMs. The usefulness of TEE in the context of PAVM is to rule out intracardiac shunts [38]. Its ability to demonstrate the interatrial septum and the insertion of the pulmonary veins into the left atrium is useful to evaluate the anatomical variations [39].
Pulmonary Arteriovenous Malformation PAVM . Similar findings have been reported in 28 PAVMs in 10 patients by Kawai et al [56]. In a recent study, Hong et al [57] studied the feasibility of time-resolved MRA in evaluating the feeding arteries and reperfusion after embolization of PAVMs in 9 patients with 62 PAVMs. They found a sensitivity and specificity of 100% for detection of reperfusion compared to catheter angiography as the reference standard. The visibility of the feeding arteries was compared to CT, and they found good correlation between 0.76 and 0.79 with 2 readers when using 3- D maximum intensity projection images. Time-resolved MRA also has the advantage of detecting reperfusion after repeat embolization for persistence as the burden of coiling will be greater leading to more metallic artifacts on CT [58]. MRA Pulmonary Arteries Without IV Contrast There is no role for the routine use of MRA pulmonary angiography without IV contrast in the workup of a patient with treated PAVM. Radiography Chest The radiographic appearance of a lower lobe pulmonary nodule with a branching afferent artery and dilated efferent vein defines the classical appearance of PAVM on chest radiography. The sensitivity of chest radiography is 60% to 70% with a 98% specificity when the classical findings are present [36]. The afferent and efferent vasculature and smaller PAVMs may be difficult to see on a single-view chest radiograph. Best diagnostic results are obtained when a 2-view chest radiograph, posteroanterior view, and lateral view is performed [37]. Chest radiography has limited usefulness to detect recurrent disease in the setting of prior treated PAVM. US Echocardiography Transesophageal There is no role for TEE as a standalone diagnostic tool in the evaluation of PAVMs. The usefulness of TEE in the context of PAVM is to rule out intracardiac shunts [38]. Its ability to demonstrate the interatrial septum and the insertion of the pulmonary veins into the left atrium is useful to evaluate the anatomical variations [39].