Objective: Helical CT scan (HCT), a noninvasive method,
can detect pulmonary arteriovenous malformations (PAVMs). Its
sensitivity is superior to that of global digitalized angiography, but
patients receive a significant dose of radiation during diagnostic HCT.
We compared HCT to contrast-enhanced pulmonary magnetic resonance
angiography (CEMRA), a new noninvasive radiation-free method, in the
diagnosis of PAVMs.
Patients and methods: Five
consecutive patients with PAVMs underwent HCT, CEMRA, and pulmonary
artery digital subtraction angiography (PADSA). CEMRA was performed
during the pulmonary arterial phase of an IV bolus of gadolinium. PADSA
was performed during the embolization procedure. All images were
examined for PAVMs. The site and size of aneurysms were specified, as
well as the diameter of the vascular pedicles.
Results: Thirty PAVMs were detected by CEMRA and 38 by HCT.
All 20 PAVMs at least 5 mm in diameter and 10 of the 18 PAVMs < 5 mm
in diameter identified on HCT were also identified by CEMRA. Whatever
the site, all PAVMs with a feeding artery diameter of at least 3 mm
(ie, PAVMs with clinical consequences) were detected by
CEMRA. No false-positive results were obtained with CEMRA. CEMRA
therefore had a sensitivity of 78% and a specificity of 100%.
Conclusions: CEMRA, a nonionizing and noninvasive
procedure, has high sensitivity and specificity for the diagnosis of
clinically relevant PAVMs.