Spectral and dual-energy CT have been studied in other anatomical locations in reducing the coil and other metallic artifacts [21,22]. There are no studies evaluating their role in PAVM, but these techniques may improve posttreatment image interpretation by reducing artifacts. For the purposes of distinguishing between CT and CT angiography (CTA), ACR Appropriateness Criteria topics use the definition in the ACR-NASCI-SIR-SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA) [23]: All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and reconstructions/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. OR Discussion of Procedures by Variant Variant 1: Presenting with a transient ischemic attack, or seizures, or brain abscess, or altered sensorium. Chest radiography reveals a lung nodule. Suspected pulmonary arteriovenous malformation (PAVM). Next imaging study. 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 angioarchitecture compared to CTA (100% versus 78%) [24]. Pulmonary angiography is performed as a part of the Pulmonary Arteriovenous Malformation (PAVM) treatment procedure and does not have a standalone diagnostic role in detecting PAVM. An exception where pulmonary angiogram would be helpful as an initial diagnostic imaging tool is in a patient who is hemodynamically unstable with clinical suspicion of pulmonary hemorrhage from a PAVM [25].
Pulmonary Arteriovenous Malformation PAVM . Spectral and dual-energy CT have been studied in other anatomical locations in reducing the coil and other metallic artifacts [21,22]. There are no studies evaluating their role in PAVM, but these techniques may improve posttreatment image interpretation by reducing artifacts. For the purposes of distinguishing between CT and CT angiography (CTA), ACR Appropriateness Criteria topics use the definition in the ACR-NASCI-SIR-SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA) [23]: All elements are essential: 1) timing, 2) reconstructions/reformats, and 3) 3-D renderings. Standard CTs with contrast also include timing issues and reconstructions/reformats. Only in CTA, however, is 3-D rendering a required element. This corresponds to the definitions that the CMS has applied to the Current Procedural Terminology codes. OR Discussion of Procedures by Variant Variant 1: Presenting with a transient ischemic attack, or seizures, or brain abscess, or altered sensorium. Chest radiography reveals a lung nodule. Suspected pulmonary arteriovenous malformation (PAVM). Next imaging study. 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 angioarchitecture compared to CTA (100% versus 78%) [24]. Pulmonary angiography is performed as a part of the Pulmonary Arteriovenous Malformation (PAVM) treatment procedure and does not have a standalone diagnostic role in detecting PAVM. An exception where pulmonary angiogram would be helpful as an initial diagnostic imaging tool is in a patient who is hemodynamically unstable with clinical suspicion of pulmonary hemorrhage from a PAVM [25].