The grading system correlates well with the diagnosis of PAVM, with higher grades associated with larger shunts and cerebral complications [41,44,45]. Usefulness of the grading system to predict treatment of PAVM demonstrates that grades 2 and 3 have a positive predictive value of 0.21 (95% CI, 0.05-0.36) and 0.87 (95% CI, 0.79-0.99), respectively [44]. Adverse events including air embolism are rare with TTCE occurring in <1% [46]. Variant 3: Asymptomatic with a family history of HHT and suspected PAVM. Initial imaging. Arteriography Pulmonary The real-time nature of pulmonary arteriography allows for high accuracy in delineating the angioarchitecture and detection of flow characteristics such as the early draining vein. In a study comparing the specificity of pulmonary arteriography and CTA, pulmonary arteriography was noted to have a higher specificity for detecting the Pulmonary Arteriovenous Malformation (PAVM) angioarchitecture compared to CTA (100% versus 78%) [24]. Pulmonary angiography is performed as a part of the treatment procedure and does not have a standalone diagnostic role in detecting PAVM. CT Chest With IV Contrast Contrast-enhanced CT chest offers high spatial resolution and can detect the number, size, and distribution of PAVMs accurately. Contrast-enhanced CT provides similar diagnostic accuracy as noncontrast CT due to the high natural contrast inherent to pulmonary anatomy. IV contrast material administration adds a small risk of air embolism in patients with PAVM. Adequate precaution should be taken to prevent air embolism [10,26]. Cross- sectional anatomy displayed on CT chest with IV contrast is useful in treatment planning [10,27]. CT Chest Without and With IV Contrast There is limited data to support obtaining a CT chest with and without IV contrast in the setting of suspected PAVM.
Pulmonary Arteriovenous Malformation PAVM . The grading system correlates well with the diagnosis of PAVM, with higher grades associated with larger shunts and cerebral complications [41,44,45]. Usefulness of the grading system to predict treatment of PAVM demonstrates that grades 2 and 3 have a positive predictive value of 0.21 (95% CI, 0.05-0.36) and 0.87 (95% CI, 0.79-0.99), respectively [44]. Adverse events including air embolism are rare with TTCE occurring in <1% [46]. Variant 3: Asymptomatic with a family history of HHT and suspected PAVM. Initial imaging. Arteriography Pulmonary The real-time nature of pulmonary arteriography allows for high accuracy in delineating the angioarchitecture and detection of flow characteristics such as the early draining vein. In a study comparing the specificity of pulmonary arteriography and CTA, pulmonary arteriography was noted to have a higher specificity for detecting the Pulmonary Arteriovenous Malformation (PAVM) angioarchitecture compared to CTA (100% versus 78%) [24]. Pulmonary angiography is performed as a part of the treatment procedure and does not have a standalone diagnostic role in detecting PAVM. CT Chest With IV Contrast Contrast-enhanced CT chest offers high spatial resolution and can detect the number, size, and distribution of PAVMs accurately. Contrast-enhanced CT provides similar diagnostic accuracy as noncontrast CT due to the high natural contrast inherent to pulmonary anatomy. IV contrast material administration adds a small risk of air embolism in patients with PAVM. Adequate precaution should be taken to prevent air embolism [10,26]. Cross- sectional anatomy displayed on CT chest with IV contrast is useful in treatment planning [10,27]. CT Chest Without and With IV Contrast There is limited data to support obtaining a CT chest with and without IV contrast in the setting of suspected PAVM.