rEmory University, Atlanta, Georgia; American Society of Echocardiography. sBrigham & Women's Hospital, Boston, Massachusetts; Committee on Emergency Radiology-GSER. tSpecialty Chair, Massachusetts General Hospital, Boston, Massachusetts. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Pulmonary Arteriovenous Malformation (PAVM) arteriovenous communication as possible. Follow-up CT angiography (CTA) to detect persistence/new lesions within 6 to 12 months followed by every 3 to 5 years is recommended by the international guidelines for the diagnosis and management of HHT [10]. Persistent perfusion of PAVMs following embolization carries the continued risk of paradoxical embolism and is a vexing problem to re-treat with success rates up to 44% to 85% [12]. The persistence rates vary with the embolic material and are primarily due to arterial recanalization. Other causes include pulmonary to pulmonary and systemic to pulmonary perfusion of the venous sac. Persistent sac perfusion following embolization with different embolic materials vary from 5% to 21% for coils alone, 4% to 6% for nitinol vascular plugs, and 0% to 2% for microvascular plugs [13,14]. Use of maximum intensity projection postprocessing has shown to increase the detection rates and reduce reporting times for small PAVMs both in children and adults. Maximum intensity projection also detects the anatomy and size of the feeding artery with higher accuracy compared to thin-section conventional CT images [18-20]. Postembolization scans for PAVMs are prone to artifacts that interfere with the evaluation of persistent flow.
Pulmonary Arteriovenous Malformation PAVM . rEmory University, Atlanta, Georgia; American Society of Echocardiography. sBrigham & Women's Hospital, Boston, Massachusetts; Committee on Emergency Radiology-GSER. tSpecialty Chair, Massachusetts General Hospital, Boston, Massachusetts. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Pulmonary Arteriovenous Malformation (PAVM) arteriovenous communication as possible. Follow-up CT angiography (CTA) to detect persistence/new lesions within 6 to 12 months followed by every 3 to 5 years is recommended by the international guidelines for the diagnosis and management of HHT [10]. Persistent perfusion of PAVMs following embolization carries the continued risk of paradoxical embolism and is a vexing problem to re-treat with success rates up to 44% to 85% [12]. The persistence rates vary with the embolic material and are primarily due to arterial recanalization. Other causes include pulmonary to pulmonary and systemic to pulmonary perfusion of the venous sac. Persistent sac perfusion following embolization with different embolic materials vary from 5% to 21% for coils alone, 4% to 6% for nitinol vascular plugs, and 0% to 2% for microvascular plugs [13,14]. Use of maximum intensity projection postprocessing has shown to increase the detection rates and reduce reporting times for small PAVMs both in children and adults. Maximum intensity projection also detects the anatomy and size of the feeding artery with higher accuracy compared to thin-section conventional CT images [18-20]. Postembolization scans for PAVMs are prone to artifacts that interfere with the evaluation of persistent flow.