Location of embolization affects patency after coil embolization for pulmonary arteriovenous malformations: importance of time-resolved magnetic resonance angiography for diagnosis of patency

• Published in: European radiology 2021-07, Vol.31 (7), p.5409-5420
• Main Authors: Shimohira, Masashi, Kiyosue, Hiro, Osuga, Keigo, Gobara, Hideo, Kondo, Hiroshi, Nakazawa, Tetsuro, Matsui, Yusuke, Hamamoto, Kohei, Ishiguro, Tomoya, Maruno, Miyuki, Sugimoto, Koji, Koganemaru, Masamichi, Kitagawa, Akira, Yamakado, Koichiro
• Format: Article
• Language: English
• Subjects: Accuracy; Angiography; Complications; Computed tomography; Diagnosis; Diagnostic Radiology; Diagnostic systems; Embolization; Imaging; Internal Medicine; Interventional; Interventional Radiology; Magnetic resonance; Medical diagnosis; Medical imaging; Medicine; Medicine & Public Health; Neurological complications; Neuroradiology; Pulmonary arteries; Pulmonary artery; Radiology; Reduction; Resonance; Sensitivity analysis; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-020-07669-w

Objectives This study aimed to assess the diagnostic accuracy of computed tomography (CT) and time-resolved magnetic resonance angiography (TR-MRA) for patency after coil embolization of pulmonary arteriovenous malformations (PAVMs) and identify factors affecting patency. Methods Data from the records of 205 patients with 378 untreated PAVMs were retrospectively analyzed. Differences in proportional reduction of the sac or draining vein on CT between occluded and patent PAVMs were examined, and receiver operating characteristic analysis was performed to assess the accuracy of CT using digital subtraction angiography (DSA) as the definitive diagnostic modality. The accuracy of TR-MRA was also assessed in comparison to DSA. Potential factors affecting patency, including sex, age, number of PAVMs, location of PAVMs, type of PAVM, and location of embolization, were evaluated. Results The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of CT were 82%, 81%, 77%, 85%, and 82%, respectively, when the reduction rate threshold was set to 55%, which led to the highest diagnostic accuracy. The sensitivity, specificity, PPV, NPV, and accuracy of TR-MRA were 89%, 95%, 89%, 95%, and 93%, respectively. On both univariable and multivariable analyses, embolization of the distal position to the last normal branch of the pulmonary artery was a factor that significantly affected the prevention of patency. Conclusions TR-MRA appears to be an appropriate method for follow-up examinations due to its high accuracy for the diagnosis of patency after coil embolization of PAVMs. The location of embolization is a factor affecting patency. Key Points • Diagnosis of patency after coil embolization for pulmonary arteriovenous malformations (PAVMs) is important because a patent PAVM can lead to neurologic complications. • The diagnostic accuracies of CT with a cutoff value of 55% and TR-MRA were 82% and 93%, respectively. • The positioning of the coils relative to the sac and the last normal branch of the artery was significant for preventing PAVM patency.