CTPA 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 [27]. Correlating the PAVM grade with contrast-enhanced echo has been shown to be more sensitive with CTPA compared to noncontrast CT [31]. Strategies to mitigate the artifacts from embolic material by adjusting scan parameters and using dual-energy and spectral CT acquisition have shown promise in other anatomical locations. For instance, Zheng et al [54] showed Pulmonary Arteriovenous Malformation (PAVM) that spectral CT using metal artifact reduction software improved vascular evaluation of adjacent metallic coils in the brain. Visualization of recanalized flow remains a challenge in posttreatment CT evaluation for reperfusion. MRA Chest Without and With IV Contrast There is no role for the routine use of MRA chest without and with IV contrast in the workup of a patient with treated PAVM. MRA Chest Without IV Contrast There is no role for the routine use of MRA chest without IV contrast in the workup of a patient with treated PAVM. MRA Pulmonary Arteries Without and With IV Contrast Dynamic MRA using time-resolved sequences has the advantage over CT, and it is not affected by the artifact from the embolic material. Time-resolved MRA can detect flow in the pulmonary vein similar to pulmonary arteriography. Shimohira et al [55] compared the sensitivity and specificity of CT and time-resolved MRA with digital subtraction angiography as a reference standard in a multi-institutional retrospective cohort of 205 patients. Using 55% as the threshold reduction of the sac diameter on CT, they found a sensitivity and specificity for CT at 82% and 81%, respectively. Time-resolved MRA on the other hand has a sensitivity and specificity of 89% and 95%, respectively.
Pulmonary Arteriovenous Malformation PAVM . CTPA 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 [27]. Correlating the PAVM grade with contrast-enhanced echo has been shown to be more sensitive with CTPA compared to noncontrast CT [31]. Strategies to mitigate the artifacts from embolic material by adjusting scan parameters and using dual-energy and spectral CT acquisition have shown promise in other anatomical locations. For instance, Zheng et al [54] showed Pulmonary Arteriovenous Malformation (PAVM) that spectral CT using metal artifact reduction software improved vascular evaluation of adjacent metallic coils in the brain. Visualization of recanalized flow remains a challenge in posttreatment CT evaluation for reperfusion. MRA Chest Without and With IV Contrast There is no role for the routine use of MRA chest without and with IV contrast in the workup of a patient with treated PAVM. MRA Chest Without IV Contrast There is no role for the routine use of MRA chest without IV contrast in the workup of a patient with treated PAVM. MRA Pulmonary Arteries Without and With IV Contrast Dynamic MRA using time-resolved sequences has the advantage over CT, and it is not affected by the artifact from the embolic material. Time-resolved MRA can detect flow in the pulmonary vein similar to pulmonary arteriography. Shimohira et al [55] compared the sensitivity and specificity of CT and time-resolved MRA with digital subtraction angiography as a reference standard in a multi-institutional retrospective cohort of 205 patients. Using 55% as the threshold reduction of the sac diameter on CT, they found a sensitivity and specificity for CT at 82% and 81%, respectively. Time-resolved MRA on the other hand has a sensitivity and specificity of 89% and 95%, respectively.